Budget impact of somatostatin analogs as treatment for metastatic gastroenteropancreatic neuroendocrine tumors in US hospitals

Figures & data

Figure 1 Model schematic.

Notes: The model schematic shows the flow of patients through the model for the two scenarios. In each scenario, those eligible for somatostatin analogs are treated with either lanreotide or octreotide. For each treatment, patients accrue costs based on the product acquisition and administration costs, which take into account dosing and the impact of failed injections. Total costs are estimated for each scenario, and compared to assess the costs of shifting utilization.
Abbreviation: GEP-NETs, gastroenteropancreatic neuroendocrine tumors.

Table 1 Model population and cost parameters

Parameter	Value	Reference
Population
Facility size (# GEP-NET patients)	500	Assumption
Proportion of GEP-NET patients with metastatic disease	80.0%	[^Citation17]
Proportion of metastatic GEP-NET patients eligible for SSA	78.2%	[^Citation21]
Costsa
Lanreotide acquisition costs, mg
60	US$4,087	[^Citation22]
90	US$5,443
120	US$6,421
Octreotide acquisition costs, mg
10	US$2,831	[^Citation22]
20	US$3,709
30	US$5,554
Preparation and mixing cost (per injection)
Lanreotide	US$0.83	[^Citation31, ^Citation32]
Octreotide	US$4.12

Note:

a Acquisition costs based on WAC as of 01/24/2017.

Abbreviations: GEP-NET, gastroenteropancreatic neuroendocrine tumor; SSA, somatostatin analog; WAC, wholesale acquisition costs.

Table 2 Product utilization parameters

Parameter	Value	Reference
Utilization by product
Initial scenario
Lanreotide	5%	[^Citation33]
Octreotide	95%
Comparison scenario
Lanreotide	30%	Assumption
Octreotide	70%
Dosing by producta
Lanreotide
60–90 mg 1× every 4 weeks	0%	[^Citation24]
120 mg 1× every 4 weeks	100%
Octreotide
10–20 mg 1× every 4 weeks	0%	[^Citation30]
30 mg 1× every 4 weeks	64%
>30 mg 1× every 4 weeksb	18%
30 mg >1× every 4 weeksc	10%
>30 mg >1× every 4 weeksd	8%

Notes:

a Dosing equivalent across scenarios.

b Among patients receiving >30 mg injections, 14% received 40 mg delivered as two 20 mg injections and 4% received 60 mg administered as two 30 mg injections.

c Among patients receiving octreotide more frequently than once every 4 weeks, 3% received injections once every 3 weeks and 7% received injections every 2 weeks.

d Among patients receiving >30 mg more frequently than once every 4 weeks, 6% received 40 mg every 3 weeks and 2% received 60 mg every 3 weeks.

Table 3 Base case resultsa,b

	Annual hospital costs		Cost per treated patient
	Initial scenario	Comparison scenario	Product acquisition	Preparation and mixing	Total
Lanreotide	US$1,305,686	US$7,834,115	US$83,473	US$11	US$83,484
Octreotide	US$26,664,769	US$19,647,725	US$89,673	US$59	US$89,732
Total	US$27,970,455	US$27,481,840	–	–	–
Differencec	–	−US$488,615	–	–	US$6,248

Notes:

a Current utilization defined as market share today, and comparison scenario defined as a hypothetical change in market share.

b Costs include medications, administration, and mixing.

c Difference reflects the change in total costs between the baseline and the comparator year. A negative number denotes a cost savings in comparator year.

Figure 2 Sensitivity analysis results: tornado diagram.

Notes: The sensitivity analysis tornado diagram indicates the impact of parameter uncertainty on the model outcomes. Each horizontal bar shows the range of differences in costs of the comparator scenario compared with the status quo scenario when varying a given parameter by ±20%. As depicted, the parameter with the greatest impact on model results was product acquisition costs, followed by the proportion of patients getting above-indicated dosing of octreotide.

ModlinIMObergKChungDCGastroenteropancreatic neuroendocrine tumoursLancet Oncol200891617218177818

 PubMed Web of Science ®Google Scholar

StrosbergJCascianoRSternLUnited States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatmentWorld J Gastroenterol201319152348235423613628

 PubMed Web of Science ®Google Scholar

Wolters KluwerPrice Rx Available from: https://pricerx.medispan.com/. Published 2016Accessed April 25, 2017

 Google Scholar

U.S. Bureau of Labor StatisticsOccupation Employment Statistics Available from: http://www.bls.gov/oes/current/oes291171.htm. Published March 2016Accessed March 28, 2016

 Google Scholar

AdelmanDTBurgessADaviesPREvaluation of long-acting somatostatin analog injection devices by nurses: a quantitative studyMed Devices (Auckl)2012510310923293542

 PubMedGoogle Scholar

BoydAEDeFordLLMaresJEImproving the success rate of gluteal intramuscular injectionsPancreas201342587888223508015

 PubMed Web of Science ®Google Scholar

SOMATULINE^® DEPOT (lanreotide) injection [prescribing Information]Ipsen Biopharmaceuticals, Inc2014

 Google Scholar

StrosbergJonathan RBobiakSarahZornosaCarrie CDosing patterns for octreotide LAR in neuroendocrine tumor (NET) patients: NCCN NET outcomes databaseJ Clin Oncol201331Suppl 154142

 Web of Science ®Google Scholar