Effectiveness and cost-effectiveness of first-line versus second-line use of repotrectinib in the treatment of ROS1 fusion-positive advanced NSCLC

This study evaluated the cost-effectiveness of repotrectinib as first-line versus second-line therapy compared with chemotherapy for advanced ROS1 fusion – positive non-small cell lung cancer (NSCLC) from a U.S. healthcare payer perspective.
A partitioned survival model was developed to estimate lifetime costs and health outcomes for three treatment strategies. Outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), using a willingness-to-pay threshold of USD 150,000 per QALY One-way, probabilistic sensitivity analyses and scenario analyses were conducted to assess model uncertainty.
Compared with chemotherapy, first-line repotrectinib yielded an additional 3.61688 QALYs at an incremental cost of $1,529,475, resulting in an ICER of $422,871 per QALY. As second-line therapy, repotrectinib provided 1.69511 additional QALYs at an incremental cost of $1,174,738, yielding an ICER of $693,016 per QALY. Both ICERs exceeded the willingness-to-pay threshold. Drug price and utility values were the main drivers of cost-effectiveness. Scenario analyses showed that reducing the price of repotrectinib to 31.843% of the base-case value lowered the ICER for first-line treatment to the WTP threshold.
Repotrectinib is not cost-effective at current prices; however, it demonstrates a more favorable cost-effectiveness profile when used as first-line therapy. Price reductions or shorter treatment durations could improve its cost-effectiveness.