OBJECTIVE: To estimate the annual costs of managing patients with advanced or metastatic ALK positive Non Small Cell Lung Cancer (NSCLC) under first line treatment with either lorlatinib or alectinib.

METHODS: Patients enter the model without brain metastases and a proportion develops metastases based in the monthly incidence. The monthly cumulative incidence of brain metastases was extracted from the ALEX trial for alectinib and the CROWN trial for lorlatinib using the WebPlotDigitizer software.

Resource use for patients with NSCLC with and without brain metastases was taken from Isla et al., 2020 and validated by local experts. The analysis included pharmacological costs and medical costs associated with managing patients with and without brain metastases (including laboratory tests, medical visits, hospitalizations, and medical procedures associated with the treatment of brain metastases). Adverse event management costs were not considered. Costs of drugs were obtained from Alfabeta.net (database of public access). Unit costs were obtained from national social security tariffs and public sector (updated to November 2021). Costs are expressed in 2021 US-dollars (exchange rate: 1 USD = ARS 100.33, average exchange rate November 2021).

RESULTS: The average total annual cost of managing a patient with lorlatinib is $98,924, of which $2,042 correspond to total medical costs and $96,883 to pharmacological costs. The average total annual cost of managing a patient with alectinib is $102,057, of which $ 2,560 correspond to total medical costs and $99,497 to pharmacological costs.

CONCLUSION: Treating patients with advanced NSCLC with lorlatinib could produce savings of $3,132 per patient per year.