Cost-utility and budget impact analyses of anaplastic lymphoma kinase inhibitors in Thailand

Second-generation anaplastic lymphoma kinase (ALK) inhibitors, including ceritinib, brigatinib, and alectinib, have improved survival in ALK-rearranged non-small-cell lung cancer (NSCLC) but are not included in Thailand's National List of Essential Medicines. This study assessed the cost-utility and budget impact of second-generation ALK inhibitors compared to chemotherapy for advanced NSCLC in Thailand. A Markov model was employed to estimate costs and quality-adjusted life years (QALYs) from a societal perspective. Cost data were derived from the Thai Health Technology Assessment Database, published literature, and clinical guidelines. Health-related quality of life (HRQoL) was assessed using EQ-5D-5L, and transitional probabilities were extracted from published studies. Incremental cost-effectiveness ratios (ICERs) and sensitivity analyses were conducted. A five-year budget impact analysis (BIA) was performed from the payer's perspective. Our analysis shows that chemotherapy remained the most cost-effective option. Although all ALK inhibitors yielded higher QALYs, the lifetime costs associated with their use cannot be offset by the additional outcomes gained. This was primarily due to Thailand's willingness-to-pay threshold, which was lower than the ICERs of all ALK inhibitors. Sensitivity analyses confirmed that none of the ALK inhibitors were cost-effective compared to chemotherapy. The five-year BIA estimated the budget impact of ceritinib (450 mg/day, 750 mg/day), alectinib (600 mg/day, 1,200 mg/day), and brigatinib at 2,345 (63.81), 3,703 (100.76), 9,830 (267.49), 19,328 (525.92), and 9,502 (258.56) million THB (USD), respectively.