Senior Manager, Value and Evidence, Lung and Colorectal Cancer Pfizer, Canada
Background: Over the past decade, the treatment landscape of anaplastic lymphoma kinase-positive (ALK+) non-small-cell lung cancer (NSCLC) has evolved tremendously, with the introduction of a new class of medications, ALK tyrosine kinase inhibitors (TKIs). Lorlatinib, a third-generation ALK TKI, was approved in March 2021 by the United States Food and Drug Administration for use as a first-line treatment for ALK+ metastatic NSCLC. Despite its efficacy and clinical guideline recommendations, it has not been routinely adopted by payers as a standard of care in the first-line setting. It is unknown how its adoption would impact payers’ budgets.
Objectives: To assess the five-year impact on payers’ budgets arising from the introduction of lorlatinib as a treatment option for patients with ALK+ metastatic/advanced NSCLC.
Methods: We developed a budget impact model using best practice guidelines and recommendations from The Professional Society for Health Economics and Outcomes Research (ISPOR). The United States commercial payer perspective was used as the base case. Eligible patients entered the model on a weekly basis according to the yearly market share inputs for each ALK TKI. In the base case, patients start treatment with lorlatinib or a comparator. After treatment discontinuation, patients may receive subsequent treatments, up to and including third-line treatment. Market shares of available drugs used to treat ALK+ metastatic/advanced NSCLC were included across first-, second- and third-lines. Treatment duration, adverse events, and central nervous system progression were considered as resource and cost variables. Parameters were varied by +/- 10% of the base value to test uncertainty in the base case results by a one-way sensitivity analysis to illustrate the most influential parameters. Scenario analyses were conducted to test different model assumptions.
Results: For a hypothetical health plan of 1,000,000 members, the introduction of lorlatinib as a first-line treatment for ALK-positive metastatic/advanced NSCLC is expected to result in a minimal yearly budget impact. The five-year increase in per member per month cost associated with the introduction of lorlatinib as a first-line treatment ranges from $0.00342 in year 1 to $0.00785 in year 5. One-way sensitivity analysis identified lorlatinib and alectinib wholesale acquisition costs as the key drivers of model results. Scenario analyses generated consistent findings.
Conclusions: Using lorlatinib in the first line setting for patients with ALK+ metastatic/advanced NSCLC results in a minimal budget impact. Along with growing clinical efficacy and safety data, this economic analysis may be used to support the use of lorlatinib in the first-line setting.
