Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4793-4806
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4793
Cost-effectiveness of lutetium (177Lu) oxodotreotide vs everolimus in gastroenteropancreatic neuroendocrine tumors in Norway and Sweden
Jayne Palmer, Oscar R Leeuwenkamp
Jayne Palmer, Ossian Health Economics and Communications, Basel 4051, Switzerland
Oscar R Leeuwenkamp, Advanced Accelerator Applications, Geneva 1204, Switzerland
Author contributions: Leeuwenkamp OR provided analysis support in conjunction with manuscript development; Palmer J prepared the first draft of the manuscript; Leeuwenkamp OR provided critical input and review to the first draft and all subsequent drafts of the manuscript. 
Institutional review board statement: No new clinical trial or patient level data were generated as part of this analysis. All data used in the analysis have been previously published, therefore institutional review board approval was not required.
Informed consent statement: No patients were directly involved in the analysis, therefore informed consent is not applicable.
Conflict-of-interest statement: Leeuwenkamp OR is a current employee of Advanced Accelerator Applications, which manufactures 177Lu-Dotatate. Palmer J is a current employee of Ossian Health Economics and Communications, which has received consulting fees from Advanced Accelerator Applications.
Data sharing statement: All input data used in the analysis are available from Leeuwenkamp OR upon reasonable request.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jayne Palmer, BSc, DPhil, Ossian Health Economics and Communications, Bäumleingasse 20, Basel 4051, Switzerland. smith-palmer@ossianconsulting.com
Received: July 8, 2020
Peer-review started: July 8, 2020
First decision: August 8, 2020
Revised: August 21, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: October 26, 2020
Processing time: 109 Days and 22.3 Hours
ARTICLE HIGHLIGHTS
Research background

177Lu oxodotreotide (177Lu-Dotatate) is a peptide receptor radionuclide therapy that was approved for use in Europe in 2017. Findings from the phase III NETTER-1 trial, conducted in patients with advanced, progressive, somatostatin-receptor-positive midgut neuroendocrine tumors (NETs) showed that the use of 177Lu-Dotatate in combination with best supportive care with octreotide long-acting release (LAR) 30 mg resulted in a significant benefit in terms of both progression-free survival (PFS) and overall survival (OS) compared with octreotide LAR 60 mg.

Research motivation

Health systems frequently have to operate within finite budgetary constraints; therefore, it is important to establish not only the efficacy but also the long-term cost-effectiveness of new treatments as they are introduced into the healthcare system.

Research objectives

The objective of the analysis was to establish the long-term cost-effectiveness of 177Lu-Dotatate compared with everolimus in patients with unresectable or metastatic midgut-NETs or pancreatic-NETs (P-NETs) in both Sweden and Norway. 

Research methods

Cost-effectiveness analysis was performed using a three-state partitioned survival model, which allows for the independent modeling of PFS and OS and the extrapolation of clinical data beyond the time frame of a clinical trial. In the absence of head-to-head trials clinical input data used in the model for the P-NET analysis were sourced from an indirect treatment comparison using input data from trials of 177Lu-Dotatate and everolimus. 

Research results

In both Sweden and Norway, treatment with 177Lu-Dotatate was associated with an incremental gain in quality-adjusted life expectancy relative to everolimus for both midgut-NETs and P-NETs, which was driven by projected improvements in PFS and OS associated with the use of 177Lu-Dotatate. For Sweden, improved survival outcomes and higher lifetime costs with 177Lu-Dotatate 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 177Lu-Dotatate compared with everolimus. For Norway the corresponding ICERs were NOK 244444 per QALY gained for midgut NETs and NOK 106,451 per QALY gained for P-NETs. 

Research conclusions

In both Sweden and Norway, 177Lu-Dotatate 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 when considered from the perspective of the healthcare provider.

Research perspectives

Based on clinical data derived through indirect comparison 177Lu-Dotatate is likely to be a cost-effective treatment option relative to everolimus for patients with midgut NETs or P-NETs based in Sweden or Norway.