Cost-Effectiveness of Adjuvant Alectinib Versus Chemotherapy for Patients with Resectable, ALK-positive Non-small Cell Lung Cancer in Canada

Nick Jovanoski (), Sarah Vaselenak, Andrew Hogan, Jasmine Turki and Quincy Chu
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Nick Jovanoski: F. Hoffmann-La Roche
Sarah Vaselenak: Hoffmann-La Roche Limited
Andrew Hogan: Hoffmann-La Roche Limited
Jasmine Turki: Hoffmann-La Roche Limited
Quincy Chu: University of Alberta

PharmacoEconomics, 2025, vol. 43, issue 7, No 9, 805-817

Abstract: Abstract Background For patients with resected non-small cell lung cancer (NSCLC), the risk of disease recurrence and progression is associated with a substantial humanistic, clinical, and economic burden. In the phase III ALINA trial (NCT03456076), adjuvant alectinib significantly improved disease-free survival (DFS) compared with chemotherapy in patients with resected ALK-positive NSCLC. Objective The aim of this study was to assess the cost-effectiveness of adjuvant alectinib versus chemotherapy for patients with resected ALK-positive NSCLC in Canada. Methods A cost–utility model comprising eight health states was developed to estimate lifetime patient outcomes and costs of patients with resected, ALK-positive NSCLC treated with adjuvant alectinib versus platinum-based chemotherapy from a societal perspective. Patterns of disease recurrence and progression were based on ALINA and other trial data; model assumptions were consistent with existing models and validated through consultation with expert Canadian clinicians. Cost-effectiveness was assessed in terms of estimated effect on life-years, quality-adjusted life-years (QALYs), and healthcare costs. In addition, scenario and probabilistic analyses were performed to explore model uncertainty. An annual discount rate of 1.5% was applied to both costs and outcomes (evaluated for 2023). Results Compared with chemotherapy, alectinib was associated with greater total life-years (19.2 versus 13.1 years) and QALYs (15.0 versus 10.1). Alectinib was dominant over platinum-based chemotherapy as it yielded a lower lifetime cost (CA $480,967.00) versus chemotherapy (CA $592,959.00). Scenario analyses showed model robustness and consistent dominance in cost-effectiveness. Probabilistic analyses results were similar to those from the base case and scenario analyses; alectinib was dominant over chemotherapy in 93.6% of simulations of incremental costs versus incremental QALYs, and remained under a willingness-to-pay threshold of CA$50,000.00 per QALY gained in 99.7% of simulations. Conclusions Our analysis suggests that adjuvant alectinib is dominant (i.e., more effective and less costly) to platinum-based chemotherapy in Canadian patients with resected ALK-positive NSCLC. Together with the DFS benefit seen in ALINA, this analysis supports adjuvant alectinib as an important new treatment strategy.

Date: 2025
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DOI: 10.1007/s40273-025-01488-x

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