Cost-effectiveness of Lutetium [¹⁷⁷Lu] oxodotreotide versus best supportive care with octreotide in patients with midgut neuroendocrine tumors in France

Abstract

Background and aims: In France, there are approximately 2,400 new cases of neuroendocrine tumors (NETs) annually. Peptide receptor radionuclide therapy with 177 Lu-Dotatate plus long-acting repeatable [LAR] octreotide 30 mg has been shown to significantly improve progression-free survival and overall survival relative to high-dose octreotide LAR 60 mg in patients with unresectable or metastatic progressive midgut NETs. A long-term cost-effectiveness analysis was performed to assess whether 177 Lu-Dotatate is a cost-effective option versus octreotide 60 mg for patients with unresectable/metastatic progressive midgut NETs from the perspective of French healthcare payer. Methods: The analysis was performed using a three-state partitioned survival model. In the base case analysis 177 Lu-Dotatate plus octreotide LAR 30 mg was compared with high-dose octreotide LAR 60 mg in patients with midgut NETs. Survival data were obtained from the phase III NETTER-1 trial in patients with metastatic midgut NETs. Future costs and clinical outcomes were discounted at 4% per annum. One-way deterministic and probabilistic sensitivity analyses were performed. Results: In the base case analysis, for patients with midgut NETs, 177 Lu-Dotatate treatment improved quality-adjusted life expectancy by 1.21 quality-adjusted life years (QALYs) relative to octreotide LAR 60 mg and the lifetime treatment costs were EUR 50,784 higher with 177 Lu-Dotatate resulting in an incremental cost-effectiveness ratio (ICER) of EUR 42,106 per QALY gained versus octreotide LAR 60 mg. When compared with everolimus, 177 Lu-Dotatate was associated with an ICER of EUR 59,769 per QALY gained. Sensitivity analyses showed that the results were sensitive to methods used to extrapolate survival data. Conclusions: For patients with advanced progressive midgut NETs 177 Lu-Dotatate is likely to be considered a cost-effective option versus octreotide 60 mg from the perspective of the French healthcare payer.

Estimation of Health-Related Utilities for 177Lu-DOTATATE in GEP-NET Patients Using Utilities Mapped from EORTC QLQ-C30 to EQ-5D-3L and QLU-C10D Utilities

“…Using three separate datasets, we have shown that the HRQoL of GEP-NET patients treated with 177 Lu-DOTA-TATE may at least remain maintained for a substantial period following treatment. The effectiveness and cost effectiveness of 177 Lu-DOTATATE have been widely recognised by several HTA agencies [29,30]. We believe our work adds to the existing body of evidence for the effectiveness of 177 Lu-DOTATATE based on the results presented for the GStT study.…”

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.…”