Real-world comparison of healthcare resource utilization and costs of [¹⁷⁷Lu]Lu-DOTA-TATE in patients with progressive neuroendocrine tumors in England: a matched cohort analysis using data from the hospital episode statistics dataset

Abstract

Objective

To explore the healthcare resource utilization (HCRU) and costs for patients with progressive gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with [¹⁷⁷Lu]Lu-DOTA-TATE and matched patients treated with somatostatin analogs (SSAs), chemotherapy, or targeted therapies.

Methods

Hospital Episode Statistics (HES) dataset 2016–2018 was used to compare HCRU and costs between the two cohorts. The [¹⁷⁷Lu]Lu-DOTA-TATE cohort included patients assigned with a diagnosis code relevant to GEP-NET, a procedure code for imaging or SSAs, and a subsequent code for radionuclide therapy. The non-[¹⁷⁷Lu]Lu-DOTA-TATE cohort included patients assigned with a diagnosis code relevant to GEP-NET who had an increased frequency of SSAs or switched from SSAs to chemotherapy or targeted therapies. Cohorts were matched on propensity scores with sex, age at disease progression, and Charlson Comorbidity Index as parameters. Healthcare Resource Group codes were used for costing.

Results

A total of 199 matched patients were included. The [¹⁷⁷Lu]Lu-DOTA-TATE cohort had lower overall costs (£1,882,028 vs. £3,016,321; p < .0001), non-elective inpatient spells (289 vs. 611 days) and costs (£849,569 vs. £1,707,109; p < .0001 for both), Accident & Emergency costs (£41,978 vs. £62,480; p = .0013), and average length of stay for overall inpatient spells (14.2 vs. 23.3 days; p = .1092) compared with the non-[¹⁷⁷Lu]Lu-DOTA-TATE cohort.

Conclusions

These analyses indicate significantly lower overall costs and HCRU for progressive GEP-NET patients treated with [¹⁷⁷Lu]Lu-DOTA-TATE. Current research reveals that future real-world analyses would further benefit from using additional databases linked to the HES dataset such as the Clinical Practice Research Datalink and/or National Cancer Registration and Analysis Service database.

PLAIN LANGUAGE SUMMARY

• Neuroendocrine neoplasms (NENs) are uncommon cancers involving the body's neuroendocrine cells. One type of NEN that is less aggressive with more favorable characteristics and prognosis is known as neuroendocrine tumor (NET). Somatostatin receptors (SSTR) are expressed by most NETs and are important treatment targets. Two-thirds of NETs originate in the body's gastroenteropancreatic system (GEP-NETs). GEP-NET is typically treated in the first instance with somatostatin analogs (SSAs), while other treatments such as chemotherapy, biologic targeted therapy, or Radio Ligand Therapy (RLT), can be offered to patients who have progressed. [¹⁷⁷Lu]Lu-DOTA-TATE is a form of RLT that has recently been approved for use in England, Wales, and Scotland.

• The purpose of this study is to analyze the utilization of healthcare resources and the costs associated with the management of GEP-NETs patients who have progressed on SSAs. This study is based on hospital data from England as available in the Hospital Episode Statistics dataset 2016–2018.

• The utilization and costs of healthcare resources were compared between two groups of patients. Following progression, one group received [¹⁷⁷Lu]Lu-DOTA-TATE, while the other group received other therapies (chemotherapy, biologic targeted therapy, or SSA with escalated or more frequent dosing). Statistical techniques were applied to enhance the comparability of analyzed groups of patients.

• The results revealed that the [¹⁷⁷Lu]Lu-DOTA-TATE group had lower inpatient admissions, outpatient appointments, and Accident & Emergency attendances compared with the non-[¹⁷⁷Lu]Lu-DOTA-TATE group. Furthermore, the overall costs in the [¹⁷⁷Lu]Lu-DOTA-TATE group were lower by 37.6%. This study indicated that patients and hospitals in England and other parts of the United Kingdom may benefit from the use of [¹⁷⁷Lu]Lu-DOTA-TATE. Further research is foreseen involving additional and linked databases, including further clinical outcomes as well.

Keywords:

• Neuroendocrine tumors
• health care costs
• resource utilization
• lutetium Lu 177 dotatate
• radiopharmaceuticals
• cost of illness

Transparency

Declaration of funding

This work was funded by Advanced Accelerator Applications/A Novartis Company, United Kingdom. In his role as coauthor, Stefan Palimaka of the funding body contributed to design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Declaration of financial/other relationships

TC and MOC are employees of Open Health, Marlow, United Kingdom at the time the study was conducted, and received funding from Advanced Accelerator Applications/A Novartis Company, United Kingdom, to conduct the study. OL is an employee of Advanced Accelerator Applications/A Novartis Company, Switzerland, and owns company shares. SP is an employee of Advanced Accelerator Applications/A Novartis Company, United Kingdom. NR is a Consultant Clinical Oncologist in Beatson Oncology Centre, Glasgow, United Kingdom, and has received payment for consultancy work, advisory boards, and speaker fees from Advanced Accelerator Applications/A Novartis Company. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All authors were involved in the conception and design, analysis and interpretation of the data, drafting or revising of the paper, and final approval of the version to be published.

Acknowledgements

This study was presented at the Virtual International Society for Pharmacoeconomics and Outcomes Research 2021 conference on May 17-20, 2021, following acceptance of the abstract. Medical writing support was provided by Anggie Wiyani, CONEXTS, Novartis Corporation (Malaysia) Sdn. Bhd., and was funded by Advanced Accelerator Applications/A Novartis Company, United Kingdom.

Data availability statement

This study is based on data from the HES dataset, provided under license to Harvey Walsh Ltd. from NHS Digital.

Notes

i ¹⁷⁷Lu-DOTATATE is a common synonym, and LUTATHERA is the proprietary name and registered trademark of Advanced Accelerator Applications, a Novartis Company.