Initiation of Somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis.
Initiation of Somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis.
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DOI：
10.1186/s12885-021-08306-5
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发表时间：
2021-05-24
期刊：
影响因子：
3.8
通讯作者：
Kim MK
中科院分区：
文献类型：
--
作者：
Rustgi SD;Oh A;Yang JY;Kang D;Wolin E;Kong CY;Hur C;Kim MK
胃肠胰神经内分泌肿瘤（GEP-NET）是异质性肿瘤。尽管有些具有相对良性和惰性的自然史，但另一些则可能具有攻击性并最终致命。一旦这些患者发生转移性疾病，生长抑素类似物（SSA）可以改善他们的生活质量和生存率。然而，这些药物价格昂贵，其成本效益尚不清楚。开发并分析了决策分析模型，以比较 IV 期 GEP-NET 患者的两种治疗策略。第一种策略让所有患者立即开始 SSA，而第二种策略则等待，保留 SSA 启动，直到患者出现进展迹象。进行敏感性分析以探讨模型参数的不确定性。我们的 60 岁转移性 GEP-NET 患者模型表明，经验性启动 SSA 导致未调整生命年增加 0.62，质量调整生命年 (QALY) 增加 0.44。每个 QALY 的增量成本为 388,966 美元，在 100,000 美元的支付意愿门槛下不具有成本效益。 SSA 组中 94.1% 的患者死于 GEP-NET，而 DELAY SSA 组中这一比例为 94.9%。敏感性分析发现，该模型对 SSA 成本最为敏感。使用概率敏感性分析，在每 QALY 的 WTP 阈值为 100,000 美元时，SSA 策略的成本效益仅为 1.4%。我们的建模研究发现，对于转移性 GEP-NET 患者，在就诊时启动 SSA 并不划算。需要进一步的临床研究来确定启动这些药物的最佳时机。
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. 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. 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. 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.
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