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BACKGROUND: This study evaluated the cost-effectiveness of repotrectinib as first-line versus second-line therapy compared with chemotherapy for advanced ROS1 fusion - positive non-small cell lung cancer (NSCLC) from a U. S. healthcare payer perspective. METHODS: A partitioned survival model was developed to estimate lifetime costs and health outcomes for three treatment strategies. Outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), using a willingness-to-pay threshold of USD 150, 000 per QALY One-way, probabilistic sensitivity analyses and scenario analyses were conducted to assess model uncertainty. RESULTS: Compared with chemotherapy, first-line repotrectinib yielded an additional 3. 61688 QALYs at an incremental cost of 1, 529, 475, resulting in an ICER of 422, 871 per QALY. As second-line therapy, repotrectinib provided 1. 69511 additional QALYs at an incremental cost of 1, 174, 738, yielding an ICER of 693, 016 per QALY. Both ICERs exceeded the willingness-to-pay threshold. Drug price and utility values were the main drivers of cost-effectiveness. Scenario analyses showed that reducing the price of repotrectinib to 31. 843% of the base-case value lowered the ICER for first-line treatment to the WTP threshold. CONCLUSIONS: Repotrectinib is not cost-effective at current prices, but first-line use is consistently more economically favorable than second-line therapy. Price reductions or shorter treatment durations could improve its cost-effectiveness.
Huo et al. (Fri,) studied this question.