Cost-effectiveness analysis of telotristat ethyl for treatment of carcinoid syndrome diarrhea inadequately controlled with somatostatin analogs

Figures & data

Figure 1. Markov model health states and patient transitions. Abbreviations. SSA, somatostatin analog; TE, telotristat ethyl.

Table 1. Base-case resource utilization and treatment input costs.

Intervention	Adequate control cost	Not adequate control cost
Resource utilization
Outpatient visit*	$650.39	$1,128.19
Outpatient pharmacy	$176.92	$597.25
Emergency department visit	$11.68	$13.85
Inpatient stay	$887.49	$1,464.32
Other medical encounters	$74.38	$156.95
Total resource use costs	$1,800.86	$3,360.56
Treatments
SSA, octreotide (24.32 mg average monthly dose)	$4,291.75	$5,890.57
Telotristat ethyl (21,000 mg average monthly dose)	$5,164.32	$5,164.32
SSA + TE	$9,456.07	$5,890.57 (discontinued TE, SSA only)

* Outpatient visit cost does not include SSA physician service and drug costs in order to avoid duplication of SSA costs in the analysis.

Table 2. Sensitivity analysis parameters for the cost-effectiveness analysis.

Parameter	Base case value	Low value	High value	Probabilistic sensitivity analysis
				Distribution	SD of the distribution
Costs
Ambulatory visit costs (AC)	$650.39	$520.31	$780.47	Gamma	$44.45
Emergency department visits (AC)	$11.68	$9.34	$14.02	Gamma	$3.38
Inpatient stays (AC)	$887.49	$709.99	$1,064.99	Gamma	$130.12
Other medical (AC)	$74.38	$59.50	$89.26	Gamma	$25.80
Outpatient pharmacy (AC)	$176.92	$141.54	$212.30	Gamma	$36.82
Ambulatory visit costs (CNA)	$1,128.19	$902.55	$1,353.83	Gamma	$47.76
Emergency department visits (CNA)	$13.85	$11.08	$16.62	Gamma	$2.11
Inpatient stays (CNA)	$1,464.32	$1,171.46	$1,757.18	Gamma	$296.66
Other medical (CNA)	$156.95	$125.56	$188.34	Gamma	$63.70
Outpatient pharmacy (CNA)	$597.25	$477.80	$716.70	Gamma	$73.26
SSA, octreotide LAR depot	$176.47	$141.18	$211.76	Gamma	$17.65
Average SSA dose
SSA only group (AC)	24.32	19.5	29.2	Normal	2.4
SSA only group (CNA)	33.38	26.7	40.1	Normal	3.3
SSA + TE group (AC)	24.32	19.5	29.2	Normal	2.4
SSA + TE group (CNA)	33.38	26.7	40.1	Normal	3.3
Treatment efficacy (12 weeks)
SSA patients with AC at end of trial	20.0%	16.0%	24.0%	Beta	0.02
SSA + TE patients with AC at end of trial	44.0%	35.2%	52.8%	Beta	0.04
Transition probability (4 weeks) from AC to CNA	1.0%	0.8%	1.2%	Beta	0.1%
Long-Term probability of mortality (every 4 weeks)	0.013	0.010	0.015	–	–
Utility
Utility (AC)	0.79	0.63	0.95	Beta	0.08
Utility (CNA)	0.32	0.24	0.36	Beta	0.03

Abbreviations. AC, adequate control; CNA, control not adequate; SSA, octreotide; SSA + TE, octreotide and telotristat ethyl.

Figure 2. Cost-effectiveness acceptability curve. Abbreviations. SSA, somatostatin analog; TE, telotristat ethyl; WTP, willingness to pay.

Figure 3. One-way sensitivity analysis results. Abbreviations. AC, adequate control; CNA, control not adequate; SSA, somatostatin analog; TE, telotristat ethyl.