OBJECTIVES: Lung cancer is one of the most prevalent cancers in men and women and has the highest mortality rate of all cancers except non-melanoma skin cancer. Approximately 85% of the cases are non-small cell lung cancer (NSCLC) and, among these, about 3% present the ALK+ translocation. The aim of this analysis is to compare costs between lorlatinib and alectinib in the ALK+ NSCLC in first line treatment from the Brazilian private healthcare system perspective.

METHODS: Randomized clinical trials were searched, aiming to find head to head comparisons between lorlatinib and alectinib. As only direct comparison trials with crizotinib were found, a systematic review with network meta-analysis (NMA) was developed to compare the efficacy (PFS and OS) and safety of lorlatinib with alectinib, with crizotinib as the common comparator. Based on the NMA results, a cost-minimization was developed. Treatment costs were calculated considering the list price approved by government in February 2022 and the dosage of each medicine included in the model.

RESULTS: NMA showed that lorlatinib was superior to alectinib for PFS (HR: 0.61; CI95%: 0.38 to 0.99), with no significant differences for OS. Treatment discontinuation rate was similar for both comparisons, suggesting class effect for both outcomes. In the cost-minimization analysis, with an annual cost of BRL 344,0 thousand per patient per year, lorlatinib has the lowest treatment cost when compared with alectinibe, which showed a cost of treatment per patient per year of BRL 368,2 thousand.

CONCLUSIONS: Considering the NMA and the lower cost of treatment compared to alectinib, lorlatinib was incorporated into the Brazilian private healthcare system in May 2022, becoming another treatment option for patients with ALK+ NSCLC.