Economics of gastroenteropancreatic neuroendocrine tumors: a systematic review

Abstract

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.

Evaluating cost-effectiveness in the management of neuroendocrine neoplasms

“…It was stated in the review by Chau et al [9] that "Although the published literature in the area of NET is substantial, there is a lack of treatment-specific and comparative economic and outcomes research data associated with commonly used treatments". In a subsequent review in 2019 Grande et al [21] suggested "further economic evaluations are required to inform healthcare decision-making". Our review demonstrates health economic literature in NEN which fulfils quality criteria for HEEs is still scarce.…”

“…Papers published from 2010 to October 2019 in English were included. We looked at treatment search terms, taking into account terms used in previous reviews by Chau et al [9] and Grande et al [21] (Table 4). See Appendix 1 for full search strategy terms.…”

“…The aim of the paper was to systematically review and critically evaluate standalone English-language literature on health economics in NEN over the last decade. Previous reviews [9,21] found limited numbers of health economic evaluations. Novel therapeutics also justify a focus on more recent evaluations.…”

Cost-Effectiveness Analysis of 68Ga DOTA-TATE PET/CT, 111In-Pentetreotide SPECT/CT and CT for Diagnostic Workup of Neuroendocrine Tumors

“…These metabolically active substances can be reason for patients to present themselves to a physician, but the majority of neuroendocrine tumors are non-functioning [ 8 ], although the resulting “carcinoid syndrome” of metabolically functional neuroendocrine tumors with an incidence of 19% is a common sign of the disease and is associated with flushing and diarrhea [ 1 , 9 ]. Other potential diseases associated with NETs are Zollinger–Ellison syndrome, hypoglycemia and bronchospasm [ 10 ]. The term of neuroendocrine carcinoma (NEC) has also been proposed for the poorly differentiated neuroendocrine neoplasms (NEN), as opposed to the well-differentiated neuroendocrine tumors (NET), and efforts are being made to uniformize the nomenclature, e.g., by the International Agency for Research on Cancer—World Health Organization (IARC-WHO) [ 11 ].…”

“…The increasing role of PET/CT imaging for neuroendocrine neoplasms, especially using SSR targeted tracers, is generally reflected by an increasing implementation and appreciation of PET/CT imaging in national and international guidelines on NETs [ 9 , 27 , 28 ]. Yet high diagnostic costs and the resulting financial burden in the context of the increasing incidence of NETs have increased the need for an additional evaluation of the diagnostic modalities from a cost-effectiveness perspective [ 10 ]. In our analysis we focus on two of the most common and widely available tracers for each modality: 68 Ga-DOTA-TATE for PET/CT imaging and 111 In-pentetreotide for SPECT/CT imaging.…”