Cost-effectiveness analysis of second-line pharmacological treatment of acromegaly in Spain

ABSTRACT

Objective

To estimate the cost-effectiveness of second-line pharmacological treatments in patients with acromegaly resistant to first-generation somatostatin analogues (FG SSA) from the Spanish National Health System (NHS) perspective.

Methods

A Markov model was developed to analyze the cost-effectiveness of pegvisomant and pasireotide in FG SSA-resistant acromegaly, simulating a cohort of patients from the treatment beginning to death. Treatment with pegvisomant or pasireotide was compared to FG SSA retreatment. Efficacy data were obtained from clinical trials and utilities from the literature. Direct health costs were obtained from Spanish sources (€2018).

Results

The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. FG SSA was €85,869/Quality-adjusted life years (QALY). The ICER of pasireotide vs. FG SSA was €551,405/QALY. The ICER was mainly driven by the incremental efficacy (4.41 QALY for pegvisomant vs. FG SSA and 0.71 QALY for pasireotide vs. FG SSA), with a slightly lower increase in costs with pegvisomant (€378,597 vs. FG SSA) than with pasireotide (€393,151 vs. FG SSA).

Conclusion

The ICER of pasireotide compared to FG SSA was six times higher than the ICER of pegvisomant vs. FG SSA. Pegvisomant is a more cost-effective alternative for the treatment of acromegaly in FG SSA-resistant patients in the Spanish NHS.

KEYWORDS:

• Acromegaly
• cost-effectiveness
• pasireotide
• pegvisomant
• somatostatin analogues

Article highlights

• In patients not fully controlled with first-generation somatostatin analogues (FG SSA), it is important to take into account not only the efficacy and safety data from pivotal clinical trials, but also to the cost-effectiveness evidence to support the decision-making process in the selection of treatment alternatives.

• The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. FG SSA was €85,869/Quality-adjusted life years (QALY).

• The ICER of pasireotide vs. FG SSA was €551,405/QALY, six times higher than the ICER of pegvisomant vs. FG SSA.

• The difference in both ICERs was mainly driven by the incremental efficacy (4.41 QALY for pegvisomant vs. FG SSA and 0.71 QALY for pasireotide vs. FG SSA), with a slightly lower increase in costs with pegvisomant (€378,597 vs. FG SSA) than with pasireotide (€393,151 vs. FG SSA).

• Pegvisomant is a more cost-effective monotherapy alternative for the treatment of acromegaly in FG SSA-resistant patients in the Spanish NHS.

Author contribution statement

CR-T and DR-R developed the economic model. FC, VG, NM, LS, and CP contributed to analysis conceptualization, design, and revision of the model. All authors had access to data, contributed to analysis conceptualization, methodology development, and manuscript preparation. All authors listed made substantial contributions to the analysis conceptualization and/or design, analysis and/or interpretation of data and manuscript preparation and/or review. All authors read, edited and approved the final manuscript. All authors agree to be accountable for all aspects of the work. CP is the guarantor of the overall content of this manuscript.

Acknowledgments

We thank Javier Parrondo at JParrondo Health for his collaboration in the development of the preliminary economic model.

Conflict of interest

This analysis was sponsored by Pfizer (Spain). CR-T and DR-R are employees of Health Value who received an honorarium from Pfizer (Spain) in connection with the development of this manuscript. Medical writing support was provided by CR-T and DR-R (Health Value) and was funded by Pfizer. CP, LS-C, and NM are employees of Pfizer (Spain). FC has received speaker honoraria from Pfizer (Spain) and Novartis. VG declared no conflict of interest.

Declaration of interest

C Peral, N Mir, and L Sánchez-Cenizo are all employees of Pfizer SLU, Madrid, Spain. F Cordido has received speaker honoraria from Pfizer (Spain). D Rubio-Rodríguez and C Rubio-Terrés are employees of Health Value who received an honorarium from Pfizer (Spain) in connection with the development of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

A reviewer on this manuscript has disclosed they have received a speaker fee from Novartis in the past. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Supplementary material

Supplementary data can be accessed here.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This analysis was sponsored, without any restriction, by Pfizer (Spain).