OBJECTIVES: To assess the cost-effectiveness of re-treatment with ¹⁷⁷Lu‑DOTATATE vs. no re-treatment with ¹⁷⁷Lu‑DOTATATE in patients with progressive midgut neuroendocrine tumors (NET), who initially received peptide receptor radionuclide therapy (I-PRRT) with ¹⁷⁷Lu‑DOTATATE, from a UK NHS and PSS perspective.

METHODS: The lifetime costs and effectiveness of treatment were simulated using a cohort-based, three-state (progression-free, progressed disease, and death) partition survival model with a 28-days cycle length. Clinical data were derived from the NETTER-1 study for patients without re-treatment and further adjusted for re-treatment based on van der Zwan et al, 2019. Cost inputs included costs for drug acquisition, concomitant medication, administration, disease monitoring and adverse events costs. Effectiveness was valued in quality-adjusted life years (QALYs), with utility weights derived from HRQoL data collected in NETTER-1 study and real world Erasmus study. Costs and effects were discounted at 3.5% per year. Uncertainty was assessed via deterministic and probabilistic sensitivity analyses.

RESULTS: At lifetime, the total cost of re-treatment with ¹⁷⁷Lu‑DOTATATE was £79,433 versus £61,559 for no re-treatment. The total QALYs for re-treatment with ¹⁷⁷Lu‑DOTATATE vs. no re-treatment were 3.84 and 2.82, respectively. The incremental cost and QALY of re-treatment was £17,874 and 1.02, respectively. The ICER for re-treatment with ¹⁷⁷Lu‑DOTATATE vs. no re-treatment was £17,553. Number of re-treatment doses of ¹⁷⁷Lu‑DOTATATE was the key driver of model results.

CONCLUSIONS: Re-treatment with ¹⁷⁷Lu‑DOTATATE seems a cost-effective option vs. no re-treatment.