Objectives: Lorlatinib is a potent 3rd generation anaplastic lymphoma kinase (ALK) inhibitor approved for the treatment of patients with ALK positive advanced non-small cell lung cancer (NSCLC) previously treated with one or more ALK tyrosine kinase inhibitors (TKIs). The present study assessed the cost-effectiveness of Lorlatinib versus pemetrexed with platinum combination of carboplatin or cisplatin (platinum based ChT) in Greece.
Methods: A partitioned survival model with three health states, referring to pre-progression, progressed disease and death, was locally adapted from a Greek payer perspective over a lifetime horizon. Clinical and safety data as well as utility values applied in the model were extracted from the literature. A matching-adjusted indirect comparison of Lorlatinib and platinum based ChT was performed. Resource consumption data were obtained from a medical expert and only direct medical costs reflecting the year 2020 were included in the analysis (€). Primary outcomes were patients’ life years (LYs), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) per QALY and LY gained. All future outcomes were discounted at 3.5% per annum. A probabilistic sensitivity analysis (PSA) was conducted to account for model uncertainty.
Results: The analysis showed that, over a lifetime horizon, total cost of Lorlatinib and platinum based ChT was estimated to be €81,754 and €12,343, respectively. Lorlatinib was more effective than platinum based ChT with 2.4 and 1.5 more LYs and QALYs gained, respectively. The generated ICERs of Lorlatinib compared to platinum based ChT were €28,613 per LY gained and €46,102 per QALY gained. PSA confirmed the deterministic results.
Conclusions: The present analysis suggests that Lorlatinib may be considered a cost-effective option over platinum based ChT in Greece, for the treatment of patients with ALK positive advanced NSCLC who have progressed after one or more ALK TKIs, while covering a significant unmet medical need.