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. 2022 May;49(6):2037-2048.
doi: 10.1007/s00259-021-05656-x. Epub 2021 Dec 24.

[177Lu]Lu-DOTA-TATE versus standard of care in adult patients with gastro-enteropancreatic neuroendocrine tumours (GEP-NETs): a cost-consequence analysis from an Italian hospital perspective

Francesca Spada  1 , Davide Campana  2 , Giuseppe Lamberti  2 , Riccardo Laudicella  3 , Renato Dellamano  4 , Luca Dellamano  4 , Oscar Leeuwenkamp  5 , Sergio Baldari  6
Affiliations

[177Lu]Lu-DOTA-TATE versus standard of care in adult patients with gastro-enteropancreatic neuroendocrine tumours (GEP-NETs): a cost-consequence analysis from an Italian hospital perspective

Francesca Spada et al. Eur J Nucl Med Mol Imaging. 2022 May.

Abstract

Purpose: To assess and compare clinical outcomes and costs, to the Italian healthcare system, of three therapeutic options approved in the management of adult patients with gastro-enteropancreatic neuroendocrine tumours (GEP-NETs).

Methods: We compared the efficacy, safety, and costs of [177Lu]Lu-DOTA-TATE, everolimus (both originator and generic products), and sunitinib in patients with advanced GEP-NETs (NET G1 and G2) that had progressed following treatment with somatostatin analogs (SSAs). A cost-consequence model was developed and validated by a panel of clinical experts from three NET reference centres in Italy. The clinical outcomes included in the model were median progression-free survival and the incidence of grade 3 or 4 adverse events (AEs), as reported in pivotal clinical trials. The costs for acquisition and administration of each treatment, and of managing AEs, were calculated from the perspective of the Italian national health service. Treatment costs per progression-free month were calculated separately for patients with NETs of pancreatic (PanNETs; all three treatments) and gastrointestinal (GI-NETs; [177Lu]Lu-DOTA-TATE and everolimus only) origin.

Results: In patients with PanNETs, total costs per progression-free month were €2989 for [177Lu]Lu-DOTA-TATE, €4975 for originator everolimus, €3472 for generic everolimus, and €5337 for sunitinib. In patients with GI-NETs, total costs per progression-free month were €3189 for [177Lu]Lu-DOTA-TATE, €4990 for originator everolimus, and €3483 for generic everolimus.

Conclusions: [177Lu]Lu-DOTA-TATE was associated with lower costs per progression-free month versus relevant treatment options in patients with GI-NETs or PanNETs (NET G1-G2; progressed following SSA treatment), although acquisition and administration costs are higher. These findings provide further economic arguments in the overall context of treatment decision-making.

Keywords: Cost-consequence analysis; Everolimus; Gastro-enteropancreatic neuroendocrine tumour; Healthcare costs; Italy; Lutetium; Peptide receptor radionuclide therapy; Progression-free survival; Somatostatin receptor agonists; Sunitinib.

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Conflict of interest statement

F.S. has received research support from Ipsen, Novartis, Pfizer, Advanced Accelerator Applications, and Merck for advisory boards and speaking engagements and is a principal investigator in clinical trials funded by GETNE, Incyte, and MSD. Additionally, F.S. has non-remunerated positions on the executive board of ITANET (Italian Neuroendocrine Tumor Society) and as a coordinator of the NEN AIOM guidelines.

L.D. and R.D. have been providing consultancy services to Advanced Accelerator Applications/A Novartis Company, Colleretto Giacosa, Italy.

O.L. is an employee of Advanced Accelerator Applications/A Novartis Company, Geneva, Switzerland, which funded the study.

D.C., G.L., R.L., and S.B. declare no conflicts of interest that are relevant to the present work.

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