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Meijuan Huang



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    P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.01-39 - Cost-Effectiveness of Crizotinib Versus Chemotherapy as First-Line Treatment of ALK Positive Advanced NSCLC -- A Real World Study (ID 12860)

      16:45 - 18:00  |  Presenting Author(s): Meijuan Huang

      • Abstract
      • Slides

      Background

      It was reported that crizotinib was a cost-effective alternative compared to pemetrexed plus platinum chemotherapy with the patient assistance program (PAP) in a model-based economic analysis using PROFILE 1014 trial data analysis. However, the cost-effectiveness of crizotinib in the real-world scenario remains unknown, which could be different from RCT results due to continued use of crizotinib beyond progression, anti-angiogenesis drugs combination in clinical practice, and influence from medical insurance (MI) policy change. The aim of study was to assess the cost-effectiveness of crizotinib vs platinum doublet chemotherapy as the first-line treatment for patients with ALK positive NSCLC in the real-world setting.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Data from 163 advanced ALK positive NSCLC patients were collected from West China Hospital, Sichuan University (Chengdu, China) between Jun 2010 and Oct 2016 with a median follow-up of 27.67 months. The median progression-free survival (m-PFS) as primary clinical outcome was analyzed by Kaplan–Meier method. Direct medical costs were collected from hospital information systems. Since the medical insurance(MI) changed during the study, two situations, including patient's entry period, and follow up period were assessed. Crizotinib, premetrexed, and angiogenesis drugs were not covered by MI in entry period. However, crizotinib and all chemotherapy drugs were MI covered during follow up period. PAP and MI reimbursement referred to local MI policy. Incremental cost-effectiveness ratio(ICER) from perspective of local healthcare systems was calculated with both costs and quality-adjusted life-years (QALYs), as well as the costs discounted at 3% annually.

      4c3880bb027f159e801041b1021e88e8 Result

      Crizotinib improved PFS vs chemotherapy in ALK positive patients. (median PFS 19. 67 m vs. 5.47 m, P < 0.001). Moreover, crizotinib obtained ICER of $36,285.39 before the end of 2016, when crizotinib, pemetrexed and anti-angiogenesis drugs were not MI covered. This is more than Willingness to pay(WTP) threshold (3-times of GDP per capita in mainland China or Sichuan Province). However, ICER was $7,321.16 which is less than WTP when crizotinib and all chemotherapy drugs were covered by MI from the end of 2016. Sensitivity analysis demonstrated a 99.7% probability for crizotinib to be more cost-effective than chemotherapy, when crizotinib and all anti-cancer drugs were MI covered. In addition, one-way sensitivity analysis for reimbursement ratio of crizotinib indicated that cost-effective tendency for crizotinib increased as reimbursement ratio increased.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our real-world analysis suggests crizotinib could be an effective, and cost-effective first-line treatment for ALK positive advanced NSCLC compared to chemotherapy with the MI coverage currently in Chengdu, China.

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