A Model-Based Cost-Effectiveness Analysis of Anamorelin and Olanzapine in NSCLC Cachexia Treatment in Japan
Author(s)
Munenobu Kashiwa, PhD1, Tatsuya Nishikawa, Bachelor of Pharmacy2, Kensuke Moriwaki, BS, MS, PhD3;
1Ritsumeikan University, Research Organization of Science and Technology, Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Kyoto City, Japan, 2Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa city, Japan, 3Ritsumeikan University, Research Organization of Science and Technology Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Kyoto city, Japan
1Ritsumeikan University, Research Organization of Science and Technology, Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Kyoto City, Japan, 2Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa city, Japan, 3Ritsumeikan University, Research Organization of Science and Technology Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Kyoto city, Japan
OBJECTIVES: Cachexia is a major complication in cancer patients, reducing treatment efficacy and increasing mortality. Anamorelin and olanzapine have shown therapeutic potential, but their cost-effectiveness remains unclear. This study aimed to assess their cost-effectiveness in patients with non-small cell lung cancer (NSCLC) and cancer cachexia.
METHODS: A Markov model was used to simulate cancer cachexia progression, including On-treatment and Post-treatment states. Patients transitioned between reversible cachexia (with and without appetite), irreversible cachexia, and death. The analysis period was 60 months, with a 2% discount rate. Probabilities for weight and appetite score changes were estimated from clinical trial data through random sampling. Direct costs were calculated using Japan's medical expense receipt database, reflecting the perspective of Japanese healthcare payers. Utility values were based on previous studies.
RESULTS: In the anamorelin group, the probability of weight change was 65.4%, and appetite score change was 70.5%. In the olanzapine group, the probability of weight change was 58.2%, and appetite score change was 43.0%. The incremental cost of anamorelin was 489,768.2 JPY, with an incremental effect of 0.0356 QALY, resulting in an ICER of 13,776,675 JPY/QALY. The incremental cost of olanzapine was 232,481.5 JPY, with an incremental effect of 0.0202 QALY, leading to an ICER of 11,518,253 JPY/QALY. Both ICER values exceeded the cost-effectiveness threshold of 5,000,000 JPY in Japan.
CONCLUSIONS: Both anamorelin and olanzapine show efficacy in NSCLC patients with cachexia, but further evaluation is needed from a cost-effectiveness perspective. Future studies should consider long-term effects and costs. Given the limitations of drug therapy alone, a comprehensive approach to cachexia, including nutritional and exercise therapy, may be necessary to enhance efficiency.
METHODS: A Markov model was used to simulate cancer cachexia progression, including On-treatment and Post-treatment states. Patients transitioned between reversible cachexia (with and without appetite), irreversible cachexia, and death. The analysis period was 60 months, with a 2% discount rate. Probabilities for weight and appetite score changes were estimated from clinical trial data through random sampling. Direct costs were calculated using Japan's medical expense receipt database, reflecting the perspective of Japanese healthcare payers. Utility values were based on previous studies.
RESULTS: In the anamorelin group, the probability of weight change was 65.4%, and appetite score change was 70.5%. In the olanzapine group, the probability of weight change was 58.2%, and appetite score change was 43.0%. The incremental cost of anamorelin was 489,768.2 JPY, with an incremental effect of 0.0356 QALY, resulting in an ICER of 13,776,675 JPY/QALY. The incremental cost of olanzapine was 232,481.5 JPY, with an incremental effect of 0.0202 QALY, leading to an ICER of 11,518,253 JPY/QALY. Both ICER values exceeded the cost-effectiveness threshold of 5,000,000 JPY in Japan.
CONCLUSIONS: Both anamorelin and olanzapine show efficacy in NSCLC patients with cachexia, but further evaluation is needed from a cost-effectiveness perspective. Future studies should consider long-term effects and costs. Given the limitations of drug therapy alone, a comprehensive approach to cachexia, including nutritional and exercise therapy, may be necessary to enhance efficiency.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE76
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, STA: Nutrition