Cost-Effectiveness of Olanzapine for Cancer Cachexia Management
Author(s)
Kathryn Perkins, PharmD1, Joshua A. Roth, MHA, PhD2, Josh Carlson, MPH, PhD3;
1CHOICE Institute, University of Washington, Seattle, WA, USA, 2Pfizer, Inc., New York, NY, USA, 3UW CHOICE Institute, Seattle, WA, USA
1CHOICE Institute, University of Washington, Seattle, WA, USA, 2Pfizer, Inc., New York, NY, USA, 3UW CHOICE Institute, Seattle, WA, USA
Presentation Documents
OBJECTIVES: Cancer cachexia, a multifactorial syndrome characterized by weight loss and muscle wasting, significantly impacts the quality of life and treatment outcomes in patients with advanced-stage Non-Small Cell Lung Cancer (NSCLC). This study evaluates the cost-effectiveness of olanzapine compared to standard of care for managing cancer cachexia in patients with advanced NSCLC.
METHODS: A Markov model with a cycle length of 1 month and life-time horizon was built to estimate costs, life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of olanzapine versus standard of care in advanced NSCLC patients with cachexia. The health states were cachexia, cachexia with weight gain, refractory cachexia, and death. Treatment related inputs for this study were from a trial of low dose olanzapine vs placebo in patients with locally advanced or metastatic cancers. FAACT quality-of-life measures were mapped to EQ5D based utility values using an algorithm by Meregaglia et al. Direct costs were expressed in 2024 US dollars, assessed from a US healthcare payer perspective, and included drug costs (wholesale acquisition costs), hospitalizations, emergency room visits, and disease related costs. One-way sensitivity analyses explored key model uncertainties.
RESULTS: In the base case, olanzapine provided marginally higher life-years (0.672 vs. 0.637; difference 0.035) and QALYs (0.313 vs. 0.288; difference 0.025) compared to standard of care, at an additional cost of $4,986. The resulting ICER was $198,743 per QALY gained. Key model drivers identified in the one-way sensitivity analysis were NSCLC disease costs, emergency and hospitalization costs, FAACT score attributed to cachexia and cachexia with weight gain health states, and mortality rate for people in the cachexia health state.
CONCLUSIONS: Results from this model indicate olanzapine is a low-cost treatment offering temporary weight gain but does not provide sufficient QALY gains to be considered cost-effective for management of cancer cachexia in advanced stage NSCLC patients.
METHODS: A Markov model with a cycle length of 1 month and life-time horizon was built to estimate costs, life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of olanzapine versus standard of care in advanced NSCLC patients with cachexia. The health states were cachexia, cachexia with weight gain, refractory cachexia, and death. Treatment related inputs for this study were from a trial of low dose olanzapine vs placebo in patients with locally advanced or metastatic cancers. FAACT quality-of-life measures were mapped to EQ5D based utility values using an algorithm by Meregaglia et al. Direct costs were expressed in 2024 US dollars, assessed from a US healthcare payer perspective, and included drug costs (wholesale acquisition costs), hospitalizations, emergency room visits, and disease related costs. One-way sensitivity analyses explored key model uncertainties.
RESULTS: In the base case, olanzapine provided marginally higher life-years (0.672 vs. 0.637; difference 0.035) and QALYs (0.313 vs. 0.288; difference 0.025) compared to standard of care, at an additional cost of $4,986. The resulting ICER was $198,743 per QALY gained. Key model drivers identified in the one-way sensitivity analysis were NSCLC disease costs, emergency and hospitalization costs, FAACT score attributed to cachexia and cachexia with weight gain health states, and mortality rate for people in the cachexia health state.
CONCLUSIONS: Results from this model indicate olanzapine is a low-cost treatment offering temporary weight gain but does not provide sufficient QALY gains to be considered cost-effective for management of cancer cachexia in advanced stage NSCLC patients.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
SA39
Topic
Study Approaches
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), SDC: Oncology