Budgetary Impact of Telotristat Ethyl, a Novel Treatment for Patients with Carcinoid Syndrome Diarrhea: A US Health Plan Perspective

Joish, Vijay N.; Frech, Feride; Lapuerta, Pablo

doi:10.1016/j.clinthera.2017.10.019

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…Our results are consistent with those from a US study that also showed a minimal budget impact on a US health plan of adding TE to SSA therapy [57]. In this study, the budget impact of adding TE totalled $US687,330 over 3 years.…”

Section: Discussionsupporting

confidence: 91%

“…In this study, the budget impact of adding TE totalled $US687,330 over 3 years. With a similar assumed market share (28% in year 1, 42% in year 2, and 55% in year 3), the net annual overall healthcare cost of TE ($US55-109 million) was well under the Institute for Clinical and Economic Review (ICER) threshold for new molecular entities ($US915 million per year) when the study was published in 2017 [57]. While the ICER decreased the threshold to $US819 million in May 2019, the budget impact of adding TE to the standard of care in the USA still falls well under this amount [58].…”

Section: Discussionmentioning

confidence: 99%

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A Budget Impact Model of the Addition of Telotristat Ethyl Treatment to the Standard of Care in Patients with Uncontrolled Carcinoid Syndrome

Fust

Maschio²,

Kohli³

et al. 2020

PharmacoEconomics

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Background Carcinoid syndrome, a rare condition in patients with neuroendocrine tumours, characterised by flushing and diarrhoea, severely affects patients' quality of life. The current carcinoid syndrome standard of care includes somatostatin analogues, but some patients experience uncontrolled symptoms despite somatostatin analogue therapy. Telotristat ethyl is a novel treatment approved by the European Medicines Agency (EMA) and US FDA that significantly reduces bowel movement frequency in patients with uncontrolled carcinoid syndrome.Objective We developed a model to evaluate the 5-year budget impact of introducing telotristat ethyl to standard care in Swedish patients with uncontrolled carcinoid syndrome. Methods Treatment response in the 12-week phase III TELESTAR trial (NCT01677910) informed telotristat ethyl efficacy; subsequently, health states were captured by a Markov model using 4-week cycles. TELESTAR open-label extension data informed telotristat ethyl discontinuation. The number of treatment-eligible patients was estimated from literature reviews reporting the prevalence, incidence and mortality of carcinoid syndrome. A Swedish database study informed real-world costs related to carcinoid syndrome and carcinoid heart disease costs. Telotristat ethyl market share was assumed to increase annually from 24% (year 1) to 70% (year 5). Results Over the 5-year model horizon, 44 patients were expected to initiate telotristat ethyl treatment. The cumulative net budget impact of adding telotristat ethyl to current standard of care was €172,346; per-year costs decreased from €66,495 (year 1) to €29,818 (year 5). Increased drug costs from adding telotristat ethyl were offset by reduced costs elsewhere. Conclusions The expected budget impact of adding telotristat ethyl to the standard of care in Sweden was relatively low, largely because of the rarity of carcinoid syndrome.Electronic supplementary material The online version of this article (https ://doi.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

A Budget Impact Model of the Addition of Telotristat Ethyl Treatment to the Standard of Care in Patients with Uncontrolled Carcinoid Syndrome

Fust

Maschio²,

Kohli³

et al. 2020

PharmacoEconomics

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“…Currently, limited data are available on the clinical practice, healthcare resource burden and costs associated with uncontrolled/refractory (i.e., requiring escalation of SSAs) CS or CHD particularly in the real-world setting. A number of studies have examined the healthcare resource use (HRU) and costs associated with the treatment of GEP-NETs and CS in the US, but published data from the European setting, particularly with a focus on CS and CHD, are scarce [22][23][24][25][26][27]. We conducted an observational, retrospective study to explore and quantify HRU and costs in relation to both controlled and uncontrolled CS, and CHD in the real-world setting, among patients diagnosed with metastatic GEP-NETs grade 1 or 2, in Sweden.…”

Section: Introductionmentioning

confidence: 99%

Real-world treatment patterns, resource use and costs of treating uncontrolled carcinoid syndrome and carcinoid heart disease: a retrospective Swedish study

Lesén

Björstad

Björholt

et al. 2018

Scandinavian Journal of Gastroenterology

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Objectives: To quantify healthcare resource use (HRU) and costs in relation to carcinoid syndrome (CS) and carcinoid heart disease (CHD) in a real-world setting, and to provide perspective on treatment patterns. Materials and methods: Patient data and HRU were collected retrospectively from three Swedish healthcare registers. Adult patients diagnosed with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) grade 1 or 2 and CS who purchased somatostatin analogs (SSAs), and experienced controlled (defined by SSAs use) and uncontrolled (defined by SSAs dose escalation) CS for !8 months during the study period were included. Patients diagnosed with CHD from the date of the GEP-NET diagnosis were included in the CHD study group. Results: Overall, total HRU cost increased with uncontrolled CS and CHD. Total resource cost was 15,500e/patient during controlled CS (8 months), rising to 21,700e/patient during uncontrolled CS (8 months), representing an increase of $40% (6200e/patient). Costs/patient were driven mainly by SSA use, tumor-related medical interventions and examinations. The total mean cost/year of disease was 1100e/patient without CHD, compared to 4600e/patient with CHD, a difference of 3500e/patient. Excluding SSA cost burden, the main drivers of increased cost in CHD patients were surgical interventions and echocardiography. Conclusions: This study provides a comprehensive overview of the treatment patterns and burden of uncontrolled CS symptoms and CHD using Swedish national register data. Increases in medical interventions and examinations HRU and increased SSA use suggest that SSA dose escalation alone may not effectively control the symptoms associated with uncontrolled CS, highlighting an unmet treatment need in this patient group.

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“…The incremental cost PMPM of reimbursing telotristat ethyl was US$0.013, US$0.019 and US$0.025 for 1, 2 and 3 years, respectively. 24…”

Section: Resultsmentioning

confidence: 99%

“…The incremental cost PMPM of reimbursing telotristat ethyl was US$0.013, US$0.019 and US$0.025 for 1, 2 and 3 years, respectively. 24 Furthermore, a model-predicted per-patient cost for SSAs was US$83,473 and US$89,673, for lanreotide and octreotide, respectively, for patients with locally advanced or metastatic GEP-NETs. 25…”

Section: Economic Evaluationmentioning

confidence: 99%

Economics of gastroenteropancreatic neuroendocrine tumors: a systematic review

Grande

Díaz

López

et al. 2019

Therapeutic Advances in Endocrinology

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Background: Despite current interest, enthusiasm and progress in the development of therapies for gastroenteropancreatic (GEP) neuroendocrine tumors (NETs), there are substantial gaps in the published literature regarding cost-of-illness analyses, economic evaluation and budget impact analyses. Compounding the issue is that data on resource utilization and cost-effectiveness of different diagnostic and therapeutic modalities for GEP-NETs are scarce. Methods: A systematic review on the economic impact of GEP-NETs was carried out using four databases: EMBASE, PubMed , the National Health Service Economic Evaluation Database and Cochrane review . Fully published articles from January 2000 to May 2017, in English and Spanish, were included. All articles that satisfied the inclusion criteria were included in the systematic review; summary descriptive statistics were used to describe the methodological characteristics. Results: The 14 studies selected included cost-of-illness analyses ( n = 4), economic evaluations ( n = 7) and budget impact analyses ( n = 3). Almost all studies were performed in the United States. Healthcare costs for patients with NETs included medication, outpatient visits, hospitalizations, and check-ups/tests. Reducing adverse events is an area where cost savings could be achieved; however, there was not enough evidence on the cost impact of adverse events. Conclusion: There is a lack of data related to resource utilization in the field of GEP-NETs. Therefore, cost-effectiveness and budget impact studies of existing and emerging treatments are urgently needed to help the decision-making process for patients with NETs.

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Budgetary Impact of Telotristat Ethyl, a Novel Treatment for Patients with Carcinoid Syndrome Diarrhea: A US Health Plan Perspective

Cited by 7 publications

References 14 publications

A Budget Impact Model of the Addition of Telotristat Ethyl Treatment to the Standard of Care in Patients with Uncontrolled Carcinoid Syndrome

A Budget Impact Model of the Addition of Telotristat Ethyl Treatment to the Standard of Care in Patients with Uncontrolled Carcinoid Syndrome

Real-world treatment patterns, resource use and costs of treating uncontrolled carcinoid syndrome and carcinoid heart disease: a retrospective Swedish study

Economics of gastroenteropancreatic neuroendocrine tumors: a systematic review

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