Author of

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  P3.11 - Poster Session 3 - NSCLC Novel Therapies (ID 211)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P3.11-048 - Cost-effectiveness analysis of crizotinib in metastatic ALK+ Non-Small Cell Lung Cancer (NSCLC) (ID 3340)

    09:30 - 09:30  |  Author(s): A.J. Montero
    • Abstract

    Background
    Crizotinib was approved in 2011 by the FDA in for treatment of patients with locally advanced or metastatic NSCLC that is ALK-positive as detected by an FDA-approved test. In order to better inform U.S. policymakers, this study aimed to assess the cost-effectiveness, from a payer perspective, of crizotinib compared to either pemetrexed or docetaxel.

    Methods
    We created a decision model using published data from the randomized phase 3 trial that led to its FDA approval, where patients with ALK+ NSCLC were randomized to receive one of the following: crizotinib (250 mg twice daily), pemetrexed (500 mg/m[2]), or docetaxel (mg/m[2]). Utilities were derived from available published literature. Costs, when available, were obtained from the Center for Medicare Services (CMS) drug payment table and physician fee schedule and were represented in 2012 U.S. dollars. Because, the price of crizotinib was not available from the most recent CMS drug payment table, we averaged three different published prices that were publically available. The quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio (ICER) were calculated. One way, two way, and probabilistic sensitivity analyses were performed.

    Results
    Since the phase 3 trial by Shaw et al. permitted cross-over to crizotinib at the time of progression, it is entirely likely that this confounded any apparent survival advantage for crizotinib. Therefore, we first evaluated our model with progression-free survival (PFS) rather than OS. Compared to docetaxel, crizotinib had an incremental benefit of 0.14 progression-free QALYs, which came at an overall cost of $102,420.04, and an incremental cost of $77,138.81, for an incremental cost effective ratio (ICER) of $535,956.19/PF-QALYs. The results of the model were robust in sensitivity analyses. The two primary drivers in this model were found to be: crizotinib cost and crizotinib median overall survival. For crizotinib to be cost effective, its monthly cost would have to be reduced from approximately $9,300 to $3,500. When we utilized OS in our model, as expected the ICER was even higher, at a cost of $1,197,005/QALY. This is expected, due to absence of a significant difference between chemotherapy and crizotinib arms in the phase 3 trial.

    Conclusion
    Crizotinib on our initial decision analytic model did not appear to be cost-effective compared to docetaxel at its current price of approximately $9,388 per month. Further analysis will be performed utilizing a Markov decision model.