Cost effectiveness of EML4-ALK fusion testing and first-line crizotinib treatment for patients with advanced ALK-positive non-small-cell lung cancer

Sandjar Djalalov, Jaclyn Beca, Jeffrey S Hoch, Murray Krahn, Ming Sound Tsao, Jean Claude Cutz, Natasha B. Leighl

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Purpose: ALK-targeted therapy with crizotinib offers significant improvement in clinical outcomes for the treatment of EML4-ALK fusion-positive non-small-cell lung cancer (NSCLC). We estimated the cost effectiveness of EML4-ALK fusion testing in combination with targeted first-line crizotinib treatment in Ontario. Patients and Methods: A cost-effectiveness analysis was conducted using a Markov model from the Canadian Public health (Ontario) perspective and a lifetime horizon in patients with stage IV NSCLC with nonsquamous histology. Transition probabilities and mortality rates were calculated from the Ontario Cancer Registry and Cancer Care Ontario New Drug Funding Program (CCO NDFP). Costs were obtained from the Ontario Case Costing Initiative, CCO NDFP, University Health Network, and literature. Results: Molecular testing with first-line targeted crizotinib treatment in the population with advanced nonsquamous NSCLC resulted in a gain of 0.011 quality-adjusted life-years (QALYs) compared with standard care. The incremental cost was Canadian $2,725 per patient, and the incremental cost-effectiveness ratio (ICER) was $255,970 per QALY gained. Among patients with known EML4-ALK-positive advanced NSCLC, first-line crizotinib therapy provided 0.379 additional QALYs, cost an additional $95,043 compared with standard care, and produced an ICER of $250,632 per QALY gained. The major driver of cost effectiveness was drug price. Conclusion: EML4-ALK fusion testing in stage IV nonsquamous NSCLC with crizotinib treatment for ALKpositive patients is not cost effective in the setting of high drug costs and a low biomarker frequency in the population.

Original languageEnglish (US)
Pages (from-to)1012-1019
Number of pages8
JournalJournal of Clinical Oncology
Volume32
Issue number10
DOIs
StatePublished - Apr 1 2014
Externally publishedYes

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Ontario
Non-Small Cell Lung Carcinoma
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Pharmaceutical Preparations
Neoplasms
Drug Costs
Population
Registries
crizotinib
Histology
Public Health
Biomarkers
Mortality
Health

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Cost effectiveness of EML4-ALK fusion testing and first-line crizotinib treatment for patients with advanced ALK-positive non-small-cell lung cancer. / Djalalov, Sandjar; Beca, Jaclyn; Hoch, Jeffrey S; Krahn, Murray; Tsao, Ming Sound; Cutz, Jean Claude; Leighl, Natasha B.

In: Journal of Clinical Oncology, Vol. 32, No. 10, 01.04.2014, p. 1012-1019.

Research output: Contribution to journalArticle

Djalalov, Sandjar ; Beca, Jaclyn ; Hoch, Jeffrey S ; Krahn, Murray ; Tsao, Ming Sound ; Cutz, Jean Claude ; Leighl, Natasha B. / Cost effectiveness of EML4-ALK fusion testing and first-line crizotinib treatment for patients with advanced ALK-positive non-small-cell lung cancer. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 10. pp. 1012-1019.
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abstract = "Purpose: ALK-targeted therapy with crizotinib offers significant improvement in clinical outcomes for the treatment of EML4-ALK fusion-positive non-small-cell lung cancer (NSCLC). We estimated the cost effectiveness of EML4-ALK fusion testing in combination with targeted first-line crizotinib treatment in Ontario. Patients and Methods: A cost-effectiveness analysis was conducted using a Markov model from the Canadian Public health (Ontario) perspective and a lifetime horizon in patients with stage IV NSCLC with nonsquamous histology. Transition probabilities and mortality rates were calculated from the Ontario Cancer Registry and Cancer Care Ontario New Drug Funding Program (CCO NDFP). Costs were obtained from the Ontario Case Costing Initiative, CCO NDFP, University Health Network, and literature. Results: Molecular testing with first-line targeted crizotinib treatment in the population with advanced nonsquamous NSCLC resulted in a gain of 0.011 quality-adjusted life-years (QALYs) compared with standard care. The incremental cost was Canadian $2,725 per patient, and the incremental cost-effectiveness ratio (ICER) was $255,970 per QALY gained. Among patients with known EML4-ALK-positive advanced NSCLC, first-line crizotinib therapy provided 0.379 additional QALYs, cost an additional $95,043 compared with standard care, and produced an ICER of $250,632 per QALY gained. The major driver of cost effectiveness was drug price. Conclusion: EML4-ALK fusion testing in stage IV nonsquamous NSCLC with crizotinib treatment for ALKpositive patients is not cost effective in the setting of high drug costs and a low biomarker frequency in the population.",
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AU - Beca, Jaclyn

AU - Hoch, Jeffrey S

AU - Krahn, Murray

AU - Tsao, Ming Sound

AU - Cutz, Jean Claude

AU - Leighl, Natasha B.

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N2 - Purpose: ALK-targeted therapy with crizotinib offers significant improvement in clinical outcomes for the treatment of EML4-ALK fusion-positive non-small-cell lung cancer (NSCLC). We estimated the cost effectiveness of EML4-ALK fusion testing in combination with targeted first-line crizotinib treatment in Ontario. Patients and Methods: A cost-effectiveness analysis was conducted using a Markov model from the Canadian Public health (Ontario) perspective and a lifetime horizon in patients with stage IV NSCLC with nonsquamous histology. Transition probabilities and mortality rates were calculated from the Ontario Cancer Registry and Cancer Care Ontario New Drug Funding Program (CCO NDFP). Costs were obtained from the Ontario Case Costing Initiative, CCO NDFP, University Health Network, and literature. Results: Molecular testing with first-line targeted crizotinib treatment in the population with advanced nonsquamous NSCLC resulted in a gain of 0.011 quality-adjusted life-years (QALYs) compared with standard care. The incremental cost was Canadian $2,725 per patient, and the incremental cost-effectiveness ratio (ICER) was $255,970 per QALY gained. Among patients with known EML4-ALK-positive advanced NSCLC, first-line crizotinib therapy provided 0.379 additional QALYs, cost an additional $95,043 compared with standard care, and produced an ICER of $250,632 per QALY gained. The major driver of cost effectiveness was drug price. Conclusion: EML4-ALK fusion testing in stage IV nonsquamous NSCLC with crizotinib treatment for ALKpositive patients is not cost effective in the setting of high drug costs and a low biomarker frequency in the population.

AB - Purpose: ALK-targeted therapy with crizotinib offers significant improvement in clinical outcomes for the treatment of EML4-ALK fusion-positive non-small-cell lung cancer (NSCLC). We estimated the cost effectiveness of EML4-ALK fusion testing in combination with targeted first-line crizotinib treatment in Ontario. Patients and Methods: A cost-effectiveness analysis was conducted using a Markov model from the Canadian Public health (Ontario) perspective and a lifetime horizon in patients with stage IV NSCLC with nonsquamous histology. Transition probabilities and mortality rates were calculated from the Ontario Cancer Registry and Cancer Care Ontario New Drug Funding Program (CCO NDFP). Costs were obtained from the Ontario Case Costing Initiative, CCO NDFP, University Health Network, and literature. Results: Molecular testing with first-line targeted crizotinib treatment in the population with advanced nonsquamous NSCLC resulted in a gain of 0.011 quality-adjusted life-years (QALYs) compared with standard care. The incremental cost was Canadian $2,725 per patient, and the incremental cost-effectiveness ratio (ICER) was $255,970 per QALY gained. Among patients with known EML4-ALK-positive advanced NSCLC, first-line crizotinib therapy provided 0.379 additional QALYs, cost an additional $95,043 compared with standard care, and produced an ICER of $250,632 per QALY gained. The major driver of cost effectiveness was drug price. Conclusion: EML4-ALK fusion testing in stage IV nonsquamous NSCLC with crizotinib treatment for ALKpositive patients is not cost effective in the setting of high drug costs and a low biomarker frequency in the population.

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