Crizotinib versus chemotherapy: a real-world cost-effectiveness study in China.
Meijuan HuangYuke TianMingmin HeJuan LiuLi RenYouling GongFeng PengYongsheng WangZhenyu DingJin WangJiang ZhuYong XuYongmei LiuLanting LiYou LuPublished in: Journal of comparative effectiveness research (2020)
Aim: To assess the cost-effectiveness of crizotinib verses platinum-based doublet chemotherapy as the first-line treatment for anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC) in the real-world setting. Methods: Data from 163 advanced ALK positive NSCLC patients were collected from West China Hospital, Sichuan University (Chengdu, China). They were categorized into two groups as treated with crizotinib (n = 83) or chemotherapy (n = 80) as a first-line therapy. The progression-free survival (PFS) as the primary clinical outcome, and the direct medical costs were collected from hospital information systems. Incremental cost-effectiveness ratio (ICER) was calculated with costs, quality-adjusted life-years, as well as the costs discounted at 3% annually. Additionally, two different kinds of medical insurance (MI) for pharma-economic assessment were considered. Results: Crizotinib improved PFS versus chemotherapy in ALK positive patients (median PFS 19.67 m vs 5.47 m; p < 0.001). Moreover, crizotinib obtained an ICER of US$36,285.39 before the end of 2016, when crizotinib, pemetrexed and anti-angiogenesis drugs were not MI covered. This is more than the willingness to pay threshold (three-times of gross domestic product per capita in mainland China or Sichuan Province). However, ICER was US$7321.16, which is less than willingness to pay, when crizotinib and all chemotherapy drugs were covered by MI from the end of 2016. Sensitivity analysis demonstrated a 99.7% probability for crizotinib to be more cost-effective than chemotherapy, when crizotinib and all anticancer drugs were MI covered. One-way sensitivity analysis for the reimbursement ratio of crizotinib indicated that cost-effective tendency for crizotinib increased as reimbursement ratio increased. Conclusion: Crizotinib could be an effective, and cost-effective first-line treatment for ALK positive advanced NSCLC with the MI coverage currently available in Chengdu, Sichuan Province, China.
Keyphrases
- advanced non small cell lung cancer
- epidermal growth factor receptor
- end stage renal disease
- healthcare
- locally advanced
- small cell lung cancer
- ejection fraction
- newly diagnosed
- squamous cell carcinoma
- chronic kidney disease
- stem cells
- machine learning
- health insurance
- bone marrow
- peritoneal dialysis
- prognostic factors
- endothelial cells
- rectal cancer
- mesenchymal stem cells
- smoking cessation
- replacement therapy
- quality improvement