Abstract
BackgroundGastroenteropancreatic 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 177Lu-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 177Lu-Dotatate in the treatment of GI-NETs and pancreatic NETs (P-NETs) in Scotland.MethodsCost-effectiveness analysis was performed from the payer perspective using a three-state partitioned survival model. In the base case 177Lu-Dotatate was compared with BSC in gastrointestinal (GI)-NETs using clinical data from the NETTER-1 trial. A secondary analysis comparing 177Lu-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.ResultsFor unresectable/metastatic progressive GI-NETs treatment with 177Lu-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 177Lu-Dotatate, leading to an incremental cost-effectiveness ratio (ICER) of GBP 26,830 per QALY gained.In analyses in patients with P-NETs 177Lu-Dotatate was associated with ICERs below GBP 30,000 per QALY gained in comparisons with BSC, sunitinib and everolimus.ConclusionsCost-effectiveness analyses demonstrated that, in Scotland, from the payer perspective, 177Lu-Dotatate at the set acquisition cost is a cost-effective treatment option for patients with unresectable or metastatic progressive GI-NETs or P-NETs.
Highlights
Gastroenteropancreatic neuroendocrine tumors (GEP-Neuroendocrine tumors (NETs)) represent a heterogenous group of tumors
A recent analysis from the European Neuroendocrine Tumor Society (ENETS) database, which included over 12,000 patients with neuroendocrine tumors across seven European countries, reported median overall survival for all patients of 178 months, this was influenced by both grade and stage [7]
It should be noted that because progression-free survival (PFS) and overall survival (OS) were longer for 177Lu-Dotatate-treated patients, both treatment and management costs were accrued over a longer period of
Summary
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a heterogenous group of tumors. The gastrointestinal (GI) tract is the primary site for approximately two thirds of all NETs with other common primary sites including the lungs and the pancreas [1, 2], tumors arising from endocrine cells in either the GI tract or pancreas are collectively termed gastroenteropancreatic (GEP) NETs. In the early stages of tumor development GEP-NETs may be asymptomatic, meaning that patients with NETs are frequently diagnosed at an advanced stage, with over 20% of patients presenting with metastatic disease at initial diagnosis [2]. Recent data from the first UK population based study of NETs reported that over the period 2013–2015 the incidence of GEP-NETs was 4.6 per 100, 000 population [4]. A recent analysis from the European Neuroendocrine Tumor Society (ENETS) database, which included over 12,000 patients with neuroendocrine tumors across seven European countries, reported median overall survival for all patients of 178 months, this was influenced by both grade and stage [7]
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