The Long-Term Avoided Recurrences and Recurrence-Related Cost of Alectinib for Postoperative Adjuvant Therapy in Chinese Patients with Early-Stage ALK-Positive Non-Small Cell Lung Cancer

Xuanxuan Yan¹Sijuan Zhou¹Xiaohua Ying^2,3*Yilong Wu^4*Jiahao Hu^1,5Yan Xia⁶Haotian He⁶Nick Jovanoski⁷Melina Arnold⁷Jian Hu⁸Pinging Song⁹Benyuan Jiang⁴Yong Zhang¹⁰

• ¹Department of Health Economics, School of Public Health, Fudan University, Shanghai, China
• ²Fudan University, Shanghai, China
• ³NHC Key Laboratory of Health Technology Assessment, China, China
• ⁴Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
• ⁵Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
• ⁶Shanghai Roche Pharmaceutical Co., Ltd, Shanghai, China
• ⁷F. Hoffmann-La Roche Ltd, Basel, Switzerland
• ⁸Department of Thoracic Surgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
• ⁹Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
• ¹⁰Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

Aims: Alectinib was approved by the US, Europe and China in 2024 as the first adjuvant targeted therapy for ALK+ NSCLC, lowering risk of disease recurrence or death by 76%. Alectinib addresses a critical gap in postoperative adjuvant therapy for ALK+ NSCLC. From Chinese healthcare-system perspective, this study evaluates the impact of introducing alectinib in adjuvant therapy for stage IB (tumor≥4cm) to IIIA (UICC/AJCC 7th edition) ALK+ NSCLC on prevention of recurrence and the associated direct medical costs, compared to platinum-based chemotherapy. Methods: A Markov model was developed to estimate the number of locoregional and metastatic recurrences over a 10-year period by defining four health states: disease-free survival, locoregional recurrence, metastatic recurrence, and death. In the control group, all patients received platinum-based chemotherapy, while in the intervention group, 75% received alectinib and 25% received platinum-based chemotherapy. Clinical data were collected from open-label, randomized phase 3 trials ALINA and ALEX. Cost parameters were derived from local charges, expert consultation, and published literature. Results: Compared to control group, the intervention group would reduce recurrences by 11,300 cases over 10 years, including 3,684 locoregional and 7,616 metastatic cases. This corresponds to a 45.82% lower recurrence rate. Estimated recurrence-related cost savings amounted to 6.9107.039 billion RMB, with 1.4451.514 billion RMB saved from locoregional recurrences and 5.4655.525 billion RMB from metastatic recurrences. This represents a 41.4941.71% reduction in costs compared to control group. These findings were robust across various scenario analyses. Conclusion: Using Alectinib in postoperative adjuvant therapy significantly reduces both the recurrence rate and recurrence-related treatment costs for stage IB (tumor≥4cm) to IIIA ALK+ NSCLC patients, compared to platinum-based chemotherapy. From perspective of Chinese healthcare system, this approach shows substantial potential for preventing recurrence and achieving cost savings.