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Cost-Effectiveness Analysis of Anlotinib as Third- or Further-Line Treatment for Relapsed Small Cell Lung Cancer
Jinhong Gong1,2, Qian Wan3, Jingjing Shang1
1Department of Pharmacy, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.
Introduction:
The survival of patients with relapsed small cell lung cancer (SCLC) has achieved little progress in the last several decades. ALTER1202 confirmed the efficacy and safety of anlotinib as a third- or further-line option for relapsed SCLC. This study aimed to assess the cost-effectiveness of anlotinib compared with placebo as third- or further-line treatment for advanced SCLC in China.
Methods:
A Markov model was developed to simulate the process of advanced SCLC and estimate the incremental cost-effectiveness ratio (ICER) of anlotinib versus placebo. The health outcomes and utilities were derived from the ALTER1202 (NCT03059797) and published sources, respectively. Total costs were calculated from the perspective of Chinese society. One-way and probabilistic sensitivity analyses (PSA) were conducted to explore the model uncertainties.
Results:
Anlotinib was estimated to result in an additional 0.12 quality-adjusted life-years (QALYs) at an incremental cost of $2131.32, resulting in an ICER of $17,741.94/QALY. The ICER did not exceed the willingness-to-pay (WTP) threshold of $30,833 per QALY, which was three times the gross domestic product (GDP) per capita of China in 2019. One-way sensitivity analysis showed that the cost of anlotinib exerted the maximum influence on the result of the model, followed by the utility of progression-free survival (PFS) state in the anlotinib group and median overall survival (mOS) in the anlotinib group. In PSA, the probability of anlotinib being cost-effective was 26.6% and 78.5% when the WTP threshold was one and three times the GDP per capita, respectively.
Conclusion:
Anlotinib is likely to be a cost-effective option compared with placebo for patients with relapsed SCLC who experience failure of at least two lines of chemotherapy in China.
Insights
Anlotinib offers a cost-effective treatment for relapsed small cell lung cancer (SCLC) in China. This analysis shows anlotinib provides improved quality-adjusted life-years (QALYs) at an acceptable cost compared to placebo for advanced SCLC patients.
Area of Science:
- Pharmacoeconomics
- Oncology
- Health Technology Assessment
Background:
- Small cell lung cancer (SCLC) survival rates have seen minimal improvement over decades, particularly for relapsed cases.
- Anlotinib has demonstrated efficacy and safety as a third- or further-line treatment for relapsed SCLC in the ALTER1202 trial.
Purpose of the Study:
- To evaluate the cost-effectiveness of anlotinib compared to placebo for advanced SCLC patients in China.
- To determine if anlotinib meets the willingness-to-pay (WTP) threshold for third- or further-line treatment in China.
Main Methods:
- A Markov model was utilized to simulate advanced SCLC progression and estimate the incremental cost-effectiveness ratio (ICER).
- Health outcomes and utilities were sourced from the ALTER1202 trial and existing literature.
- Economic analysis was conducted from a Chinese societal perspective, including sensitivity analyses (one-way and probabilistic).
Main Results:
- Anlotinib is projected to yield an additional 0.12 quality-adjusted life-years (QALYs) with an incremental cost of $2131.32, yielding an ICER of $17,741.94/QALY.
- The calculated ICER falls below China's 2019 WTP threshold of $30,833 per QALY (three times GDP per capita).
- Sensitivity analyses indicated anlotinib cost and patient survival utilities significantly influence the model; probabilistic analysis showed a 78.5% likelihood of cost-effectiveness at three times GDP per capita WTP.
Conclusions:
- Anlotinib represents a likely cost-effective treatment option for patients with relapsed SCLC who have failed at least two prior chemotherapy lines in China.
- The findings support anlotinib's value in improving patient outcomes within the Chinese healthcare economic context for advanced SCLC.
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