A Budget Impact Analysis To Estimate The Cost Savings From Alectinib On Patients With Anaplastic Lymphoma Kinase (Alk) Positive Locally Advanced Or Metastatic Non-Small Cell Lung Cancer (Nsclc) Previously Treated With Crizotinib

To assess the economic impact of alectinib for patients with ALK+ locally advanced or metastatic NSCLC previously treated with crizotinib, focusing on the efficacy of alectinib in both systemic disease and CNS metastasis related symptoms. A 3-year budget impact model was developed for Italy for the period 2017─2019. Docetaxel and ceritinib were considered as representative comparators of alectinib in Italy. Clinical inputs (e.g. dosing regimens, treatment duration, progression free survival (PFS), CNS complete response and duration of CNS response) were obtained from the literature and the pooled analysis of two phase II clinical studies for comparative treatments and alectinib respectively. Market shares forecasting and epidemiological data on NSCLC prevalence, ALK test rates and rates of patients who discontinued crizotinib were provided by Roche Italy. Costs and resource use were derived from the literature. The cost savings from response to CNS metastasis were deducted from the total cost for each treatment in order to estimate the overall budget impact. The population with ALK+ NSCLC was determined to be approximately 350 patients per year for Italy, which shows the low budget impact of this indication for the National Healthcare System. Estimating the incremental budget impact with and without alectinib and taking into account the potential cost savings from delay and prevention of appearance of CNS metastasis, the analysis showed that when alectinib is introduced in the market, cost savings between 5% and 18% of the total budget impact can be achieved over the three years period, compared to the scenario when alectinib is not a treatment option. The analysis showed that introducing alectinib in the market is a beneficiary option for the healthcare system and the patients since it is likely to reduce the healthcare budget while providing longer control of systemic disease and related CNS metastasis.