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Everolimus Has Minimal Economic Impact on Treatment of Pancreatic NETs

March 2012, Vol 3, No 2

San Francisco, CA—Using a prediction model to analyze the impact of adding targeted agents to the treatment of pancreatic neuroendocrine tumors (pNETs), everolimus (Afinitor) had a minimal overall impact on healthcare expenditures, by reducing infusions and surgical procedures costs, according to a study presented at the 2012 Gastrointestinal Cancers Symposium. For patients with advanced pNETs, the median overall survival is typically approximately 2 years. Everolimus was recently approved for the treatment of advanced, progressive pNET based on a significant 65% reduction in risk of disease progression. It is expected, therefore, that oncologists will be incorporating this mTOR inhibitor into their treatment plans for this patient population. Roman Casciano, MS, of Analytica International, New York, and colleagues developed a budget impact model from a US payer's perspective to simulate a typical health plan with 1 million covered lives.

Study Details

The eligible patient population was derived using the incidence of advanced pNETs of 0.001%. Patients with advanced, nonprogressive pNETs account ed for 60% of the population, and patients with advanced, progressive tumors accounted for 40%. Treatments included chemotherapy (capecitabine, doxorubicin, streptozocin, temozolomide), the new targeted agents everolimus and sunitinib (Sutent), and best supportive care. Treatment utili zation was based on a previous study of resource utilization in the treatment of pNETs. Drug costs were derived from the 2011 Micromedex RED BOOK, and medical resource utilization costs were taken from the 2011 MAG Mutual Physicians' Fee and Coding Guide. Treatment-related grade 3/4 adverse event rates were obtained from clinical trials, whereas the cost of management was based on secondary literature.

Economic Impact of Various Therapies for pNETs.
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Before the approval of sunitinib and everolimus, 43% of patients with pNETs received chemotherapy and 57% received best supportive care alone, Mr Casciano and colleagues determined. After the approval of these 2 new therapies, the prediction model assumed that 14% of patients would receive chemotherapy, 13% would receive everolimus, and 16% would receive sunitinib. The researchers constructed a scenario to evaluate the economic impact of increasing and decreasing the market share of everolimus relative to sunitinib. The model estimated the annual aggregate budget impact, stratified by resource, and budget impact per member per month. Prevalence estimates applied to the hypothetical population yielded 12 patients with advanced pNETs. Stratifying the annual cost by treatment comparators, the investigators determined that the use of targeted therapies was associated with a budget increase of $53,927 in a hypothetical healthcare plan of 1 million subscribers; however, reductions in cost from other comparators produced the net increase of $22,657 (Table), according to Mr Casciano.

In the base-case analysis, this amounted to an increase of only $0.0019 per member per month, or $0.0227 per member per year, he said. "The antitumor treatment costs composed the largest percent increase, 601%, in cost among all healthcare resource costs. Conversely, infusion costs decreased by 68% and surgical procedure costs decreased by about 35%," he noted. Scenario analyses showed that increases in the share of everolimus relative to sunitinib (29% everolimus vs 2% sunitinib) resulted in a lower aggregate economic impact, or an additional cost to the plan of $18,000. Increasing the market share of sunitinib relative to everolimus (0% everolimus vs 29% sunitinib) yielded a higher aggregate economic impact compared with the base-case analysis, which assumed 13% of patients received everolimus and 16% received sunitinib.

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