OBJECTIVES : Ceritinib was approved to be used for patients with drug resistant to crizotinib among non-small cell lung cancer (NSCLC) patients with anaplastic lymphoma kinase mutation (ALK+). This study assessed the cost-effectiveness of ceritinib versus chemotherapy among ALK+ NSCLC patients previously treated with crizotinib and chemotherapy from the US healthcare perspective.

METHODS : Markov model with three health states (progression-free, progression, and death) and partitioned survival model (PartSA) were developed over a 5-year time horizon, respectively. Progression free survival and overall survival for ceritinib and chemotherapy were estimated from clinical trials ASCEND-2, ASCEND-5, and PROFILE-1007. Drug and drug delivery cost, monitoring cost, and cost for adverse events were obtained from literature and inflated to 2018 US dollars. Utilities at health states were derived from literature. 3% annual discount rate was applied to costs and utilities. Incremental cost per quality-adjusted life year (QALY) was estimated for ceritinib versus chemotherapy with $150,000/QALY as US willingness-to-pay threshold. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to test the robustness of the models.

RESULTS : In Markov model, ceritinib yielded 13.01 QALYs and $336,673 over 5 years, while chemotherapy yielded 14.28 QALYs and $349,774 in costs. Compared to chemotherapy, an incremental cost of -$13,101 and an incremental effectiveness of -1.27 QALY was yielded by choosing ceritinib. In PartSA model, an incremental cost of $12,884.95 and an incremental effectiveness of -0.87 QALY was yielded by choosing ceritinib. The Markov model and PartSA model results remained robust in sensitivity analyses. Both models were most sensitive to parameters of medical cost for progression disease and cost of ceritinib.

CONCLUSIONS : From both models, ceritinib is not cost effective compared to chemotherapy among patients previously treated with crizotinib and chemotherapy, from the US healthcare perspective.