Taletrectinib in ROS1+ non–small cell lung cancer: a cost-effectiveness analysis in the United States

Objective: To evaluate the cost-effectiveness by comparing four treatment strategies for ROS1-positive non-small cell lung cancer (NSCLC): first-line taletrectinib prior to chemotherapy, second-line taletrectinib following chemotherapy, second-line taletrectinib after crizotinib, and chemotherapy alone. Methods: A partitioned survival model was constructed to analyze the clinical outcomes and healthcare expenditures associated with the four treatment strategies. Costs and utility values were obtained from reputable literature sources and publicly available cost databases. Cost-effectiveness was evaluated under different taletrectinib cost scenarios to determine the impact of taletrectinib pricing on the four treatment strategies. Results: All three taletrectinib-containing treatment strategies exceeded the established U.S. willingness-to-pay (WTP) threshold of $150,000 per QALY, indicating they were not cost-effective. Among the evaluated strategies, first-line taletrectinib administered prior to chemotherapy provided the largest gain in quality-adjusted life years (QALYs), adding 4.61372 QALYs. However, this came at a substantial additional cost of $1,263,183.95, resulting in an incremental cost-effectiveness ratio (ICER) of $273,789 per QALY compared to chemotherapy alone. The second-line use of taletrectinib following crizotinib provided a more favorable cost-effectiveness profile. It yielded an additional 2.03260 QALYs at an additional cost of $441,371.10, leading to an ICER of $217,146 per QALY compared to chemotherapy. While all three strategies demonstrated ICERs above the WTP threshold, the second-line approach following crizotinib offered the most favorable, though still not cost-effective, cost-effectiveness compared to the other options. Conversely, second-line taletrectinib administered following chemotherapy exhibited the poorest cost-effectiveness, with an ICER of $587,663 per QALY. Furthermore, the sensitivity analysis highlighted that the cost of taletrectinib was the primary driver of the ICER's unfavorable results. Conclusion: Based on current pricing, none of the taletrectinib-containing treatment strategies were found to be cost-effective for patients with ROS1-positive NSCLC compared to chemotherapy alone, as their ICERs exceeded the established WTP threshold. Nevertheless, considering the individual patient's priorities, a personalized approach to treatment decisions can be adopted. For patients prioritizing the maximization of QALYs and with the necessary financial resources, first-line taletrectinib prior to chemotherapy may be a preferred option. Conversely, for those with limited financial capacity or in contexts prioritizing cost-containment, second-line taletrectinib after crizotinib could be more suitable.