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Cost effectiveness of EML4-ALK fusion testing and first-line crizotinib treatment for patients with advanced ALK-positive non-small-cell lung cancer.
J Clin Oncol. 2014 Apr 1;32(10):1012-9
Publication Type
Sandjar Djalalov
Jaclyn Beca
Jeffrey S Hoch
Murray Krahn
Ming-Sound Tsao
Jean-Claude Cutz
Natasha B Leighl
Author Affiliation
Sandjar Djalalov, Jaclyn Beca, and Jeffrey S. Hoch, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital and Cancer Care Ontario; Sandjar Djalalov, Jaclyn Beca, Jeffrey S. Hoch, Murray Krahn, and Natasha B. Leighl, Canadian Centre for Applied Research in Cancer Control; Murray Krahn, Toronto Health Economics and Technology Assessment Collaborative; Ming-Sound Tsao and Natasha B. Leighl, Ontario Cancer Institute and Princess Margaret Cancer Centre, Toronto; and Jean-Claude Cutz, McMaster University, Hamilton, Ontario, Canada.
J Clin Oncol. 2014 Apr 1;32(10):1012-9
Publication Type
Antineoplastic Agents - economics - therapeutic use
Carcinoma, Non-Small-Cell Lung - chemistry - drug therapy - economics
Cost-Benefit Analysis
Gene Frequency
Immunohistochemistry - economics
Lung Neoplasms - chemistry - drug therapy - economics
Neoplasm Staging
Oncogene Proteins, Fusion - analysis - genetics
Pyrazoles - economics - therapeutic use
Pyridines - economics - therapeutic use
Quality-Adjusted Life Years
Sensitivity and specificity
Tumor Markers, Biological - analysis
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.
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.
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.
EML4-ALK fusion testing in stage IV nonsquamous NSCLC with crizotinib treatment for ALK-positive patients is not cost effective in the setting of high drug costs and a low biomarker frequency in the population.
Comment In: J Clin Oncol. 2014 Apr 1;32(10):983-524567437
PubMed ID
24567430 View in PubMed
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