Initiation of Somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis

Rustgi, Sheila D.; Oh, Aaron; Yang, Jeong Yun; Kang, Dasol; Wolin, Edward M.; Kong, Chung Yin; Hur, Chin; Kim, Michelle K.

doi:10.1186/s12885-021-08306-5

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…We identified systemic therapy, specifically somatostatin analogs, as the primary driver of high cost in this population of patients, in line with findings from previous studies from other countries. [24][25][26] Our study adds to the growing body of literature 21,24,26,28 that supports careful consideration of limiting the upfront use of somatostatin analogs, particularly in patients with low-grade disease, to optimize high value care. Future studies using this methodology should incorporate the cost of PRRT to reflect the current state of metastatic NEN treatment, study the impact of insurance type on the CCPD and survival, and aim to capture costs at other institutions or health care systems for comparison to identify best practices for delivering highvalue care.…”

Section: Discussionmentioning

confidence: 62%

Computing the Cost of Care per Patient per Day for Patients With Metastatic Neuroendocrine Neoplasms

Gupta,

Barnes,

Qin

et al. 2024

JCO Oncol Pract

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PURPOSE Patients with well-differentiated, low-grade metastatic neuroendocrine neoplasms (NENs) usually have a long median survival and require complex, expensive care over many years at multidisciplinary centers. The cost burden for patients and institutions serves as a barrier to care. Understanding the drivers of these costs and whether intense monitoring adds value will help to optimize value-based care. METHODS We adapted the cost of care per patient per day (CCPD) validated methodology to measure cost while accounting for varying follow-up duration. We queried the Stanford NEN Database, which aggregates data from the electronic health record and other electronic sources, to study patients with metastatic NENs receiving regular care at Stanford. Current Procedural Terminology codes for services incurred during the monitoring period for each patient were mapped to the corresponding cost conversion factor and date in the Medicare fee schedule. RESULTS Two hundred two patients between 2010 and 2017 were studied with a mean CCPD of $119.11 in US dollars (USD); NEN-specific systemic therapy made up 55% of this cost. Somatostatin analogs were the costliest systemic therapy. Systemic therapy was the driver of cost differences among patients with various primary tumor types, stage of disease, tumor differentiation and grade, and functional hormone status. Patients in the most expensive CCPD group did not have a significant survival benefit ( P = .66). CONCLUSION The CCPD methodology was effective in studying cancer care value in NENs. Systemic therapy, specifically somatostatin analogs, was the primary driver of cost, and intense monitoring and higher-cost care did not improve survival outcomes.

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Section: Discussionmentioning

confidence: 62%

Computing the Cost of Care per Patient per Day for Patients With Metastatic Neuroendocrine Neoplasms

Gupta,

Barnes,

Qin

et al. 2024

JCO Oncol Pract

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“…Several analyses have shown that RLT is a cost-effective alternative to systemic treatment in other cancers such as neuroendocrine tumors. [25][26][27][28] In the diagnostic process, the proPSMA trial has shown the superior diagnostic value of 68 Ga-PSMA-PET compared with conventional imaging in patients with prostate cancer, and it has also proved to be less costly. 29 Besides primary staging, the early detection of metastasis also has a high value in recurrent disease, such as in the setting of oligometastatic disease 30 and in differentiating nonmetastatic from metastatic prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer

Mehrens

Kramer

Unterrainer

et al. 2023

Journal of the National Comprehensive Cancer Network

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Background: Metastatic castration-resistant prostate cancer poses a therapeutic challenge with poor prognosis. The VISION trial showed prolonged progression-free and overall survival in patients treated with lutetium Lu 177 vipivotide tetraxetan (177Lu-PSMA-617) radioligand therapy compared with using the standard of care (SoC) alone. The objective of this study was to determine the cost-effectiveness of 177Lu-PSMA-617 treatment compared with SoC therapy. Methods: A partitioned survival model was developed using data from the VISION trial, which included overall and progression-free survival and treatment regimens for 177Lu-PSMA-617 and SoC. Treatment costs, utilities for health states, and adverse events were derived from public databases and the literature. Because 177Lu-PSMA-617 was only recently approved, costs for treatment were extrapolated from 177Lu-DOTATATE. Outcome measurements included the incremental cost, effectiveness, and cost-effectiveness ratio. The analysis was performed in a US setting from a healthcare system perspective over the lifetime horizon of 60 months. The willingness-to-pay threshold was set to $50,000, $100,000, and $200,000 per quality-adjusted life years (QALYs). Results: The 177Lu-PSMA-617 group was estimated to gain 0.42 incremental QALYs. Treatment using 177Lu-PSMA-617 led to an increase in costs compared with SoC ($169,110 vs $85,398). The incremental cost, effectiveness, and cost-effectiveness ratio for 177Lu-PSMA-617 therapy was $200,708/QALYs. Sensitivity analysis showed robustness of the model regarding various parameters, which remained cost-effective at all lower and upper parameter bounds. In probabilistic sensitivity analysis using Monte Carlo simulation with 10,000 iterations, therapy using 177Lu-PSMA-617 was determined as the cost-effective strategy in 37.14% of all iterations at a willingness-to-pay threshold of $200,000/QALYs. Conclusions: Treatment using 177Lu-PSMA-617 was estimated to add a notable clinical benefit over SoC alone. Based on the model results, radioligand therapy represents a treatment strategy for patients with metastatic castration-resistant prostate cancer with cost-effectiveness in certain scenarios.

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“…Although SSA discontinuation for high-grade toxicity is rare, the incidence of low-grade toxicity is significant ( Sorbye et al 2020 ), with adverse events in prospective trials ranging from 31 to 51% ( Caplin et al 2014 , Wolin et al 2015 , Strosberg et al 2017 , Pavel et al 2021 ). Two recent cost-effectiveness analyses (representative of US prices) showed a high cost per quality-adjusted life year in some situations and are indicative of the financial burden of SSA treatment ( Joish et al 2018 , Rustgi et al 2021 ). We thus examined whether lower SSA doses might be equally effective.…”

Section: Discussionmentioning

confidence: 99%

Treatment efficacy in a metastatic small intestinal neuroendocrine tumour grade 2 cohort

Papantoniou

Grönberg

Thiis‐Evensen

et al. 2023

Endocrine-Related Cancer

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Small intestinal neuroendocrine tumours (Si-NET) are often studied as a uniform group. Proliferation index Ki-67 influences prognosis and determines tumour grade. We hypothesized that Si-NET grade 2 (G2), which have a higher Ki-67 than G1 tumours, might benefit less from established treatments for metastatic disease. We conducted a retrospective cohort study of 212 patients with metastatic Si-NET G2 treated in two Swedish hospitals during 20 years (2000-2019). Median cancer-specific survival (CSS) on first-line somatostatin analogues (SSA) was 77 months. Median progression-free survival (PFS) was 12.4 months when SSA was given as monotherapy, and 19 months for all patients receiving first-line SSA. PFS after SSA dose escalation was 6 months in patients with radiological progression. Treatment efficacies of SSA and peptide-receptor radionuclide treatment (PRRT) were studied separately in patients with Ki-67 of 3-5%, 5-10% and 10-20%. For SSA, PFS was significantly shorter at higher Ki-67 levels (31, 18 and 10 months, respectively) while there was only a minor difference in PFS for PRRT (29, 25 and 25 months). Median PFS for sequential treatment with interferon-alpha (IFNa), everolimus and chemotherapy was 6, 5 and 9 months. IFNa seemed to be effective in tumours with low somatostatin-receptor expression. In conclusion, established treatments appeared effective in Si-NET G2, despite their higher proliferation index compared to G1 tumours. However, efficacy of SSA but not PRRT was reduced at higher Ki-67 levels. SSA dose escalation provided limited disease stabilization.

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Initiation of Somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis

Cited by 8 publications

References 38 publications

Computing the Cost of Care per Patient per Day for Patients With Metastatic Neuroendocrine Neoplasms

Computing the Cost of Care per Patient per Day for Patients With Metastatic Neuroendocrine Neoplasms

Cost-Effectiveness Analysis of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer

Treatment efficacy in a metastatic small intestinal neuroendocrine tumour grade 2 cohort

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