Cost-effectiveness of everolimus vs sunitinib in treating patients with advanced, progressive pancreatic neuroendocrine tumors in the United States

Abstract

Background:

Everolimus (Afinitor) and sunitinib (Sutent) were recently approved to treat patients with advanced, progressive pancreatic neuroendocrine tumors (pNETs). (Afinitor is a registered trademark of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; Sutent is a registered trademark of Pfizer Inc., New York, NY, USA.) This analysis examined the projected cost-effectiveness of everolimus vs sunitinib in this setting from a US payer perspective.

Methods:

A semi-Markov model was developed to simulate a cohort of patients with advanced, progressive pNET and to estimate the cost per life-year gained (LYG) and per quality-adjusted life-year (QALY) gained when treating with everolimus vs sunitinib. Efficacy data were based on a weight-adjusted indirect comparison of the agents using phase 3 trial data. Model health states included: stable disease with no adverse events, stable disease with adverse events, disease progression, and death. Therapy costs were based on wholesale acquisition cost. Other costs such as physician visits, tests, hospitalizations, and adverse event costs were obtained from literature and/or primary research. Utility inputs were based on primary research. Sensitivity analyses were conducted to test the model’s robustness.

Results:

In the base-case analysis, everolimus was associated with an incremental 0.448 LYG (0.304 QALYs) at an incremental cost of $12,673, resulting in an incremental cost-effectiveness ratio (ICER) of $28,281/LYG ($41,702/QALY gained). The ICER fell within the cost per QALY range for many widely used oncology drugs. Sensitivity analyses demonstrated that, overall, there is a trend that everolimus is cost-effective compared to sunitinib in this setting.

Limitations:

Results of the indirect analysis were not statistically significant (p > 0.05). Assumptions that treatment patterns are the same across therapies may not represent real-world practice.

Conclusions:

While the analysis is limited by its reliance on an indirect comparison of two phase 3 studies, everolimus is expected to be cost-effective relative to sunitinib in advanced, progressive pNET.

Keywords::

• Pancreatic neuroendocrine tumors
• Everolimus
• Sunitinib

Transparency

Declaration of funding

Novartis Pharmaceuticals Corporation provided funding for this study. The sponsored research did not put limits on freedom to publish or the content of the publication.

Declaration of financial/other relationships

Roman Casciano, Maruit Chulikavit, and Allison Perrin are employees of The LA-SER Group, a consultancy that received compensation for the overall economic study design, the analysis, and preparation of this manuscript. Zhimei Liu and Xufang Wang are employees of and own stock in Novartis Pharmaceuticals Corporation. They also contributed to the analysis and manuscript preparation. Louis P. Garrison is a consultant for Novartis Pharmaceuticals Corporation and has received compensation for his contributions to analysis and the preparation of the manuscript.

Acknowledgments

No assistance in the preparation of this article to be declared. This study was presented in part (Figure 1 and Tables 1–3, 5, and 6) at the American Society of Clinical Oncology, 2012 Gastrointestinal Cancers Symposium; Science and Multidisciplinary Management of GI Malignancies; January 19–21, San Francisco, CA. The poster was titled, Cost-Effectiveness of Treating Patients with Advanced Progressive Pancreatic Neuroendocrine Tumors with Everolimus Versus Sunitinib in the United States.