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. 2021 May 24;21(1):597.
doi: 10.1186/s12885-021-08306-5.

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

Sheila D Rustgi  1   2 , Aaron Oh  2 , Jeong Yun Yang  3 , Dasol Kang  4 , Edward Wolin  5 , Chung Y Kong  6 , Chin Hur  2 , Michelle K Kim  7
Affiliations

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

Sheila D Rustgi et al. BMC Cancer. .

Abstract

Background & aims: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are heterogeneous neoplasms. Although some have a relatively benign and indolent natural history, others can be aggressive and ultimately fatal. Somatostatin analogues (SSAs) improve both quality of life and survival for these patients once they develop metastatic disease. However, these drugs are costly and their cost-effectiveness is not known.

Methods: A decision-analytic model was developed and analyzed to compare two treatment strategies for patients with Stage IV GEP-NETs. The first strategy had all patients start SSA immediately while the second strategy waited, reserving SSA initiation until the patient showed signs of progression. Sensitivity analysis was performed to explore model parameter uncertainty.

Results: Our model of patients age 60 with metastatic GEP-NETs suggests empiric initiation of SSA led to an increase 0.62 unadjusted life-years and incremental increase in quality-adjusted life years (QALYs) of 0.44. The incremental costs were $388,966 per QALY and not cost-effective at a willingness-to-pay threshold of $100,000. Death was attributed to GEP-NETs for 94.1% of patients in the SSA arm vs. 94.9% of patients in the DELAY SSA arm. Sensitivity analysis found that the model was most sensitive to costs of SSAs. Using probabilistic sensitivity analysis, the SSA strategy was only cost-effective 1.4% of the time at a WTP threshold of $100,000 per QALY.

Conclusions: Our modeling study finds it is not cost-effective to initiate SSAs at time of presentation for patients with metastatic GEP-NETs. Further clinical studies are needed to identify the optimal timing to initiate these drugs.

Keywords: Carcinoid; Cost-effectiveness analysis; Neuroendocrine tumors; Peptide receptor radionuclide therapy; Somatostatin analogues.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Model Diagram. The figure is a simplified schematic of the Markov model. Circles represent health states and arrows represent transitions. Acronyms: NET = neuroendocrine tumor; SSA = somatostatin analogues; PRRT = Peptide Receptor Radionuclide Therapy
Fig. 2
Fig. 2
Tornado Diagram – Incremental Cost-Effectiveness Ratio (ICER). The bars indicate the ICERs that result from the range of parameter inputs. NET = Neuroendocrine Tumor; SSA = somatostatin analogues; PRRT = Peptide Receptor Radionuclide Therapy; EV = expected value in base case
Fig. 3
Fig. 3
Cost-Effectiveness Acceptability Curve. SSA = somatostatin analogues
See this image and copyright information in PMC

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