OBJECTIVES: In the phase III ALEX study, alectinib demonstrated superior progression-free survival over crizotinib for treatment-naïve patients with ALK+ NSCLC. This study aims to evaluate health resource utilization (HRU) and costs for patients receiving alectinib or crizotinib as the first ALK inhibitor (ALKi).

METHODS: This retrospective observational study identified patients ≥ 18 years old with lung cancer (ICD-9: 162, ICD-10: C34) receiving their first ALKi between 1/1/2015 and 6/30/2019 from PharMetrics Plus claims database. Patients were required to have continuous medical and pharmacy enrollment 6 months before and 12 months after the first ALKi initiation date (index date) and no prior ALKi treatment during the 6 months pre-index. HRU and per-patient-per-month (PPPM) costs (reported in 2019 USD) during the 12 months post-index were summarized by index ALKi. A multivariate generalized linear model with log-link and gamma distribution was applied to estimate total cost of care, adjusting for baseline characteristics.

RESULTS: The study included 53 alectinib and 124 crizotinib patients. In the 12 months post-index, alectinib patients were less likely to have any emergency department (ED) and inpatient visits compared with crizotinib patients (ED: 24.5% vs 40.3%, p=0.044; inpatient: 22.6% vs 41.3%, p=0.019). Although ALKi pharmacy costs were similar (unadjusted PPPM cost: $12,749 vs $12,825, p=0.933), total cost of care was lower for alectinib patients than for crizotinib patients (unadjusted PPPM cost: $18,461 vs $21,307, p=0.069]. After adjusting for baseline characteristics, total cost of care for alectinib patients was 19.5% lower than crizotinib patients (adjusted PPPM cost: $15,536 vs $19,303, p=0.005).

CONCLUSIONS: In this study, patients receiving alectinib as the first ALKi had approximately 20% lower mean adjusted total cost of care compared with patients receiving crizotinib. This real-world economic evidence supplements clinical benefits from the ALEX study, supporting the use of alectinib as the first ALKi in ALK+ NSCLC patients.