Cost of managing brain metastases in patients with ALK+ advanced NSCLC with first-line tyrosine kinase inhibitors in the UK

INTRODUCTION: This study aimed to estimate the NHS costs of managing patients with anaplastic lymphoma kinase positive (ALK+) advanced non-small-cell lung cancer (aNSCLC), with and without brain metastases. Patients were treated with first-line (1 L) ALK tyrosine kinase inhibitors (TKIs). METHODS: We built an economic model to estimate the annual costs of managing ALK+ aNSCLC patients with and without brain metastases using estimated NHS health care resource use (HCRU) consumption. The ALK TKIs included in our model were lorlatinib, crizotinib, alectinib and brigatinib. We based our estimates on the cumulative incidence of brain metastases in four clinical trials - CROWN, ALEX, ALESIA and ALTA-1L. RESULTS: For the first year of treatment, our model estimated the annual cost of managing patients with brain metastases to be £14,870. Patients without brain metastases cost £4,133. The NHS HCRU cost savings generated by treating patients with lorlatinib increased significantly over time and were greater in patients without brain metastases at the start of their treatment (at baseline) with lorlatinib. This reflects the prevention of brain metastases with 1 L lorlatinib. CONCLUSION: + aNSCLC.