Cost-Effectiveness Analysis of the Five First-line Treatment Regimens for ALK-positive NSCLC in China: An Economic Evaluation Based on Network Meta-Analysis.

BACKGROUND: With multiple first-line treatment options now available for advanced ALK-positive non-small cell lung cancer (NSCLC), clinicians and patients face significant challenges in selecting the optimal therapeutic strategy. This study aims to evaluate the cost-effectiveness of five tyrosine kinase inhibitors (TKIs) as first-line therapies from the perspective of the Chinese healthcare system. METHODS: Using crizotinib as a common comparator, we performed indirect comparisons across five ALK-TKIs by reconstructing survival data and applying fractional polynomial models to estimate time-varying hazard ratios. A partitioned survival model was developed to assess cost-effectiveness. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were conducted to evaluate model robustness. Primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was set at $27,906.00/QALY. RESULTS: Compared to crizotinib, the ICERs for lorlatinib, alectinib, ensartinib, brigatinib, and iruplinalkib were $4,674.43/QALY, $5,361.28/QALY, $199,751.00/QALY, -$29,623.06/QALY, and $4,652.70/QALY, respectively. Iruplinalkib yielded the highest QALY gain, while brigatinib was associated with the lowest total cost. DSA identified utility values and drug prices as key drivers of the ICERs. At a WTP threshold of $27,906/QALY, PSA indicated that iruplinalkib had the highest probability (75.70%) of being cost-effective. CONCLUSION: For patients with advanced ALK-positive NSCLC in China, lorlatinib, alectinib, brigatinib, and iruplinalkib are cost-effective compared to crizotinib, with the exception of ensartinib. Among these, iruplinalkib is the most cost-effective TKI for first-line treatment, followed by lorlatinib.