Lutetium oxodotreotide ( 177 Lu-Dotatate) for the treatment of unresectable or metastatic progressive gastroenteropancreatic neuroendocrine tumors: a cost-effectiveness analysis for Scotland

• Published in: BMC cancer 2021-01, Vol.21 (1), p.10-10, Article 10
• Main Authors: Smith-Palmer, J, Leeuwenkamp, O R, Virk, J, Reed, N
• Format: Article
• Language: English
• Subjects: Analysis; Cost; Cost analysis; Cost-Benefit Analysis; Cost-effectiveness; Disease Progression; Economic analysis; Follow-Up Studies; Gastroenteropancreatic neuroendocrine tumors; Humans; Intestinal Neoplasms - economics; Intestinal Neoplasms - pathology; Intestinal Neoplasms - radiotherapy; Life expectancy; Life span; Lutetium; Lutetium - economics; Lutetium - therapeutic use; Medical care, Cost of; Medical prognosis; Metastases; Metastasis; Neoplasm Metastasis; Neuroendocrine system; Neuroendocrine tumors; Neuroendocrine Tumors - economics; Neuroendocrine Tumors - pathology; Neuroendocrine Tumors - radiotherapy; Octreotide; Octreotide - chemistry; Organometallic Compounds - economics; Organometallic Compounds - therapeutic use; Pancreas; Pancreatic Neoplasms - economics; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - radiotherapy; Patients; Prognosis; Quality-Adjusted Life Years; Radionuclides; Radiopharmaceuticals - economics; Radiopharmaceuticals - therapeutic use; Scotland; Secondary analysis; Stomach Neoplasms - economics; Stomach Neoplasms - pathology; Stomach Neoplasms - radiotherapy; Survival
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-07710-7

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a heterogenous group of tumors. Findings from the phase III NETTER-1 trial showed that treatment of unresectable/metastatic progressive gastrointestinal (GI) NETs with Lu-Dotatate resulted in a significant improvement in progression-free survival (PFS) and overall survival (OS) compared with best supportive care (BSC) with high dose octreotide long-acting repeatable (LAR) 60 mg. A health economic analysis was performed using input data from clinical studies and data derived from an indirect comparison to determine the cost-effectiveness of Lu-Dotatate in the treatment of GI-NETs and pancreatic NETs (P-NETs) in Scotland. Cost-effectiveness analysis was performed from the payer perspective using a three-state partitioned survival model. In the base case Lu-Dotatate was compared with BSC in gastrointestinal (GI)-NETs using clinical data from the NETTER-1 trial. A secondary analysis comparing Lu-Dotatate with BSC, everolimus or sunitinib in patients with P-NETs was also performed using hazard ratios inferred from indirect comparisons. The base case analysis was performed over a 20-year time horizon with an annual discount rate of 3.5% for both costs and clinical outcomes. For unresectable/metastatic progressive GI-NETs treatment with Lu-Dotatate led to a gain in quality-adjusted life expectancy of 1.33 quality-adjusted life years (QALYs) compared with BSC due to extended PFS and OS. Mean total lifetime costs were GBP 35,701 higher with Lu-Dotatate, leading to an incremental cost-effectiveness ratio (ICER) of GBP 26,830 per QALY gained. In analyses in patients with P-NETs Lu-Dotatate was associated with ICERs below GBP 30,000 per QALY gained in comparisons with BSC, sunitinib and everolimus. Cost-effectiveness analyses demonstrated that, in Scotland, from the payer perspective, Lu-Dotatate at the set acquisition cost is a cost-effective treatment option for patients with unresectable or metastatic progressive GI-NETs or P-NETs.