PCN93 Treatment of Well-Differentiated Pancreatic Neuroendocrine Tumors With Sunitinib in Patients With Disease Progression: Cost-Utility and Cost-Effectiveness Analysis

Abstract

To perform cost-utility (CUA) and cost-effectiveness (CEA) analysis of sunitinib in combination with the best supportive care (BSC) in treatment of well-differentiated pancreatic neuroendocrine tumors (p-NET), unresectable or with metastases. The Markov model constructed in TreeAge Pro 2009 was used in the analysis. The time horizon covered the period from start of treatment until the patient's death (lifetime horizon). Study Raymond 2011 and poster Ishak 2011 were the source of data on the efficacy of sunitinib and the health states utility. As the measure of effectiveness quality adjusted life years (QALY), life years gained (LYG) and life years gained without disease progression (LYGPF) were used and the results were presented as incremental cost-utility/effectiveness ratio (ICUR/ICER). CUA and CEA analyses were conducted from the perspective of the public payer for health services (Polish National Health Fund, PNHF) and from the patient and PNHF perspective. Following direct medical costs were included: sunitinib, administration of the drug, diagnostic and monitoring, somatostatin analogues, BSC, severe adverse events and palliative care. Discount rate of 5% for costs and 3.5% for benefits were used. The cost of gaining an additional QALY replacing placebo+BSC by sunitinib+BSC is 84,214 PLN/84,296 PLN (€20,441/€20,461) from PNHF/PNHF+patient perspective. Similarly, the cost of gaining an additional LYG is 58,450 PLN/58,507 PLN (€14,188/€14,201) and the cost of gaining an additional LYGPF is 79,868 PLN/79,946 PLN (€19,386/€19,405). Sunitinib+BSC is more costly and more effective therapy. Obtained results are placed below the acceptability threshold in Poland (which is about 99,543 PLN (€24,162)). The 2011 weighted average exchange rate of Polish National Bank was €1 = PLN 4.1198. The reimbursement of sunitinib would bring benefits to patients for whom there is currently no other effective treatment option. Sunitinib in combination with BSC prolongs overall survival and time to next progression.