Palmer J, Leeuwenkamp OR. Cost-effectiveness of lutetium (177Lu) oxodotreotide vs everolimus in gastroenteropancreatic neuroendocrine tumors in Norway and Sweden. World J Clin Cases 2020; 8(20): 4793-4806 [PMID: 33195647 DOI: 10.12998/wjcc.v8.i20.4793]
Corresponding Author of This Article
Jayne Palmer, BSc, DPhil, Ossian Health Economics and Communications, Bäumleingasse 20, Basel 4051, Switzerland. smith-palmer@ossianconsulting.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2020; 8(20): 4793-4806 Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4793
Cost-effectiveness of lutetium (177Lu) oxodotreotide vs everolimus in gastroenteropancreatic neuroendocrine tumors in Norway and Sweden
Jayne Palmer, Oscar R Leeuwenkamp
Jayne Palmer, Ossian Health Economics and Communications, Basel 4051, Switzerland
Oscar R Leeuwenkamp, Advanced Accelerator Applications, Geneva 1204, Switzerland
Author contributions: Leeuwenkamp OR provided analysis support in conjunction with manuscript development; Palmer J prepared the first draft of the manuscript; Leeuwenkamp OR provided critical input and review to the first draft and all subsequent drafts of the manuscript.
Institutional review board statement: No new clinical trial or patient level data were generated as part of this analysis. All data used in the analysis have been previously published, therefore institutional review board approval was not required.
Informed consent statement: No patients were directly involved in the analysis, therefore informed consent is not applicable.
Conflict-of-interest statement: Leeuwenkamp OR is a current employee of Advanced Accelerator Applications, which manufactures 177Lu-Dotatate. Palmer J is a current employee of Ossian Health Economics and Communications, which has received consulting fees from Advanced Accelerator Applications.
Data sharing statement: All input data used in the analysis are available from Leeuwenkamp OR upon reasonable request.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jayne Palmer, BSc, DPhil, Ossian Health Economics and Communications, Bäumleingasse 20, Basel 4051, Switzerland. smith-palmer@ossianconsulting.com
Received: July 8, 2020 Peer-review started: July 8, 2020 First decision: August 8, 2020 Revised: August 21, 2020 Accepted: September 25, 2020 Article in press: September 25, 2020 Published online: October 26, 2020 Processing time: 109 Days and 22.3 Hours
Abstract
BACKGROUND
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a relatively rare and heterogenous group of tumors. Currently available treatment options for patients with progressive GEP-NETs include lutetium (177Lu) oxodotreotide (177Lu-Dotatate) and everolimus [as well as sunitinib for patients with pancreatic NETs (P-NETs)].
AIM
To perform a health economic analysis to determine the cost-effectiveness of 177Lu-Dotatate compared with everolimus in patients with unresectable or metastatic midgut-NETs or P-NETs in both Sweden and Norway.
METHODS
Simulations were performed using a three-state partitioned survival model and analyses were performed separately for patients with midgut-NETs and P-NETs. Clinical input data were sourced from an indirect comparison that utilized survival data from clinical trials of 177Lu-Dotatate and everolimus. The analyses were performed from the healthcare payer perspective over a time horizon of 20 years. For Sweden, future costs and clinical outcomes were discounted at 3% per annum. For Norway, a discount rate of 4% per annum was applied.
RESULTS
For Sweden, improved survival outcomes and higher lifetime costs with 177Lu-Dotatate resulted in an incremental cost-effectiveness ratio (ICER) of SEK 391194 per quality-adjusted life year (QALY) gained for midgut NETs and SEK 16764 per QALY gained for P-NETs for 177Lu-Dotatate compared with everolimus. For Norway, the corresponding ICERs were NOK 244444 per QALY gained and NOK 106451 per QALY gained, respectively. One-way sensitivity analyses revealed that the results were most sensitive to changes in drug acquisition costs and health state utility values.
CONCLUSION
In both Sweden and Norway, from a healthcare provider perspective, 177Lu-Dotatate is likely to be considered cost-effective relative to everolimus for the treatment of patients with unresectable or metastatic, progressive midgut-NETs or P-NETs.
Core Tip: Peptide receptor radionuclide therapy with 177lutetium oxodotreotide (177Lu-Dotatate; Lutathera), which targets the overexpression of somatostatin receptors, particularly the somatostatin receptor type 2 expressed on the surface of tumor cells in some neuroendocrine tumors (NETs), is an efficacious new treatment approach for patients with gastroenteropancreatic NETs. To be adopted into routine clinical practice, new treatments should also be cost-effective as well as efficacious. Long-term health economic analyses suggest that in Sweden and Norway 177Lu-Dotate is likely to be cost-effective and associated with minimal budget impact relative to everolimus for the treatment of unresectable or metastatic progressive midgut or pancreatic NETs.
