Incremental effectiveness of crizotinib for treating ros1-positive advanced non-small-cell lung cancer in portugal

To evaluate the effectiveness of crizotinib in the treatment of ROS1+ non-small cell lung cancer (NSCLC) in the Portuguese NHS. A previously developed and validated state-transition Markov cohort model was used. The model reflects the clinical pathway for patients with ROS1+ NSCLC, capturing differences in outcomes related to disease progression and treatment discontinuation rates. The model was adapted to consider relevant treatment strategies to Portuguese setting and clinical practice. The model was populated with epidemiological and health-related-quality-of-life data relevant to Portugal. First-line treatment with crizotinib was compared with pemetrexed+platinum and followed by docetaxel (second-line) and best-supportive-care (BSC, third-line) in case of disease progression. Similarly, after first-line treatment with pemetrexed+platinum, second-line treatment with crizotinib was compared with docetaxel followed by BSC (third-line). Deterministic and probabilistic sensitivity analyses were performed for key model parameters to assess both parameter and structural uncertainty. A treatment strategy considering crizotinib as first-line option (vs pemetrexed+platinum) resulted on an average of 1.51 added life years (LYs) and 1.34 quality adjusted life years (QALYs). A treatment strategy considering crizotinib as second-line option (vs docetaxel) resulted on an average of 2.00 added LYs and 1.73 added QALYs. In both first and second lines, patient response to crizotinib was substantial (>65%) within the first year of assessment. Sensitivity analyses of key model parameters indicated that model results were generally robust, but sensitive to the treatment-specific utility estimates. Compared to standard first and second-line treatment with chemotherapy, treatment with crizotinib in patients with ROS1+ NSCLC can be considered an effective treatment option for the Portuguese NHS setting.