A Cost-effectiveness Analysis of Adjuvant Alectinib in Patients With Resectable ALK-positive Non-small Cell Lung Cancer in the United States

Objectives: We evaluated the cost-effectiveness of adjuvant alectinib versus adjuvant platinum-based chemotherapy for patients with resectable (stage IB to IIIA) ALK + non-small cell lung cancer using a US societal perspective. Methods: We developed a cohort-level Markov model to compare adjuvant alectinib versus platinum-based chemotherapy using a lifetime time horizon (40 y) with a monthly cycle length and 3% discounting of health state utilities and costs. Patients started in a disease-free health state; downstream health states included treated (first- or second-line) or untreated metastatic or nonmetastatic recurrence, or death. Patient characteristics, adjuvant treatment patterns, and health utilities were based on the ALINA trial. Results: When measured across a lifetime time horizon, adjuvant alectinib was estimated to lead to 3.1 additional quality-adjusted life-years (QALYs) with $429,925 lower total costs per patient, demonstrating a dominant cost-effectiveness ratio compared with adjuvant platinum-based chemotherapy (more effective and less costly). The net monetary benefit in favor of adjuvant alectinib was $895,766 at a willingness-to-pay (WTP) threshold of $150,000/QALY gained. In probabilistic sensitivity analysis, adjuvant alectinib has a 99.6% probability of being more effective and less costly than adjuvant chemotherapy. The incremental cost-effectiveness ratio for adjuvant alectinib remained dominant when all model inputs were varied in the one-way sensitivity analysis. Conclusions: In comparison with platinum-based chemotherapy, adjuvant alectinib offers substantial additional clinical and economic value to society.