Cost-effectiveness of lutetium(~(177)Lu)oxodotreotide vs everolimus in gastroenteropancreatic neuroendocrine tumors in Norway and Sweden

摘要

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(177 Lu)oxodotreotide(177 LuDotatate)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 177 LuDotatate 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 177 Lu-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 177 LuDotatate 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 177 Lu-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,177 LuDotatate 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.