Cost-effectiveness analysis of pancreatin minimicrospheres in patients with pancreatic exocrine insufficiency due to chronic pancreatitis

Abstract

Objective:

Chronic pancreatitis (CP) is the most common cause of pancreatic exocrine insufficiency (PEI). Management of PEI due to CP is achieved through lifelong treatment with pancreatic enzyme replacement therapy (PERT). To the authors’ knowledge, no cost-effectiveness analysis on the benefit of PERT in CP patients with PEI has been performed to date. The objective of this analysis was to examine the cost-effectiveness of Creon (pancreatin minimicrospheres [MMS]), one of the main PERTs available in Poland, in treating patients with CP-related PEI.

Methods:

The cost-effectiveness of pancreatin MMS in the treatment of patients with CP-related PEI vs no PERT treatment was estimated using a decision analysis based on clinical data from relevant studies. The model horizon was 20 years. Main outcomes included the percentage of patients with controlled PEI, survival, total medical costs, number of quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). All costs were analysed from the Polish payer perspective.

Results:

The model included clinical data from 176 patients treated in five pancreatin MMS randomized trials. Treatment with pancreatin MMS resulted in a considerably higher proportion of patients with controlled PEI compared to those not treated with any PERT. Over a horizon of 20 years, the total treatment cost and the ICER for pancreatin MMS was €8223 and €6312 per QALY, respectively.

Limitations:

Important limitations include the lack of long-term and comparative clinical data available. The use of ‘no PERT treatment’ as a comparator against pancreatin MMS treatment may not accurately reflect current practice in Poland.

Conclusions:

Treatment of CP-related PEI with pancreatin MMS is cost-effective from a Polish payer perspective, with an ICER below the accepted ‘willingness to pay’ threshold of 3-times gross domestic product (GDP) per capita. These results are likely to apply to other European countries.

Keywords::

• Chronic pancreatitis
• Pancreatic exocrine insufficiency
• Pancreatin
• Cost-effectiveness analysis
• Cost utility analysis
• Health economic model

Abbreviations::

• AHTAPol, Agency for Health Technology Assessment in Poland; CFA, Coefficient of fat absorption; CI, Confidence interval; CP, Chronic pancreatitis; GDP, Gross domestic product; HRQoL, Health-related quality-of-life; ICER, Incremental cost-effective ratio; LOCF, Last observation carried forward; MMS, Minimicrosphere; P, Placebo; PEI, Pancreatic exocrine insufficiency; PERT, Pancreatic enzyme replacement therapy; PMM, Pancreatin minimicrospheres; PSA, Probabilistic sensitivity analysis; QALY, Quality-adjusted life year; QoL, Quality-of-life; RCT, Randomized clinical trial; SA, Sensitivity analysis; SD, Standard deviation

Transparency

Declaration of funding

The research described in this article, the drafting of this manuscript, and its publication were funded by Abbott Products Operations A.G., Switzerland.

Declaration of financial/other relationships

Anke van Engen, Julia Morawski, and Anja Prüfert have disclosed that they are employees of Quintiles Consulting and that funding for their medical writing support came from Abbott A.G. Douglas Foerster and Suntje Sander-Struckmeier are employees of Abbott. Raffaele Pezzilli contributed as co-author and has collaborated in the past on both Abbott and Quintiles sponsored projects. Ewa Małecka-Panas contributed as a co-author and has also collaborated with Abbott in the past on sponsored projects and events. All authors have participated in the design, data analysis, and drafting of this article.