Lutetium oxodotreotide (177Lu-Dotatate) for the treatment of unresectable or metastatic progressive gastroenteropancreatic neuroendocrine tumors: a cost-effectiveness analysis for Scotland

Abstract

Background Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a heterogenous group of tumors. Findings from the phase III NETTER-1 trial showed that treatment of unresectable/metastatic progressive gastrointestinal (GI) NETs with 177Lu-Dotatate resulted in a significant improvement in progression-free survival (PFS) and overall survival (OS) compared with best supportive care (BSC) with high dose octreotide long-acting repeatable (LAR) 60 mg. A health economic analysis was performed using input data from clinical studies and data derived from an indirect comparison to determine the cost-effectiveness of 177Lu-Dotatate in the treatment of GI-NETs and pancreatic NETs (P-NETs) in Scotland. Methods Cost-effectiveness analysis was performed from the payer perspective using a three-state partitioned survival model. In the base case 177Lu-Dotatate was compared with BSC in gastrointestinal (GI)-NETs using clinical data from the NETTER-1 trial. A secondary analysis comparing 177Lu-Dotatate with BSC, everolimus or sunitinib in patients with P-NETs was also performed using hazard ratios inferred from indirect comparisons. The base case analysis was performed over a 20-year time horizon with an annual discount rate of 3.5% for both costs and clinical outcomes. Results For unresectable/metastatic progressive GI-NETs treatment with 177Lu-Dotatate led to a gain in quality-adjusted life expectancy of 1.33 quality-adjusted life years (QALYs) compared with BSC due to extended PFS and OS. Mean total lifetime costs were GBP 35,701 higher with 177Lu-Dotatate, leading to an incremental cost-effectiveness ratio (ICER) of GBP 26,830 per QALY gained. In analyses in patients with P-NETs 177Lu-Dotatate was associated with ICERs below GBP 30,000 per QALY gained in comparisons with BSC, sunitinib and everolimus. Conclusions Cost-effectiveness analyses demonstrated that, in Scotland, from the payer perspective, 177Lu-Dotatate at the set acquisition cost is a cost-effective treatment option for patients with unresectable or metastatic progressive GI-NETs or P-NETs.

Survival predictors of 177Lu-Dotatate peptide receptor radionuclide therapy (PRRT) in patients with progressive well-differentiated neuroendocrine tumors (NETS)

“…The response predictors of this novel treatment have not yet been well described in the literature. Moreover, while 177 Lu-Dotatate is reported to be cost-effective at a national level (Smith-Palmer et al 2021 ), the unit cost is sufficiently high to warrant further investigation to identify those most likely to benefit from treatment. In this report, we describe several prognostic factors of adverse outcome and recurrent disease.…”

Neuroendocrine neoplasms: Consensus on a patient care pathway

“…Furthermore, at each stage along the care pathway, cost-efficiency can be maximised through a comprehensive understanding of the patient population, health system capacity and resources, as well as the most appropriate diagnostic tools, treatments and supportive care interventions. There is some evidence of the cost-effectiveness of specific treatments for NENs, 94,95,[131][132][133][134][135][136][137] and cost-efficiency of care pathways for other conditions has been demonstrated. [13][14][15][16][17][18] It is important to note, however, that there is currently insufficient evidence on the costeffectiveness of many types of NEN management.…”

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

“…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.…”