COST-EFFECTIVENESS ANALYSIS OF SECOND-LINE PHARMACOLOGICAL TREATMENTS OF ACROMEGALY IN SPAIN
Author(s)
Peral C1, Cordido F2, Gimeno V3, Sanchez-Cenizo L1, Mir N1, Parrondo J4
1Pfizer S.L.U., Alcobendas (Madrid), Spain, 2Hospital A Coruña, A Coruña, Spain, 3Hospital Miguel Servet, Zaragoza, Spain, 4JParrondo Health, Madrid, Spain
OBJECTIVES: To estimate the cost-effectiveness of second line pharmacological treatments in patients with acromegaly resistant to somatostatin analogues (SSA) from the perspective of the Spanish National Health System (NHS). METHODS: A Markov model was constructed to analyze the cost-effectiveness of pegvisomant and pasireotide in SSA-resistant acromegaly, simulating the progression of the disease in a cohort of patients from the beginning of treatment to death. The model allowed the estimation of the quality-adjusted life-years (QALYs) from the perspective of the Spanish NHS. Treatment with pegvisomant or pasireotide was analyzed and compared to somatostatin analogues (SSA) retreatment. Efficacy data was obtained from clinical trials and the utilities were sourced from the literature. The direct health costs were calculated based on published Spanish data (€2016). A univariate sensitivity analysis was performed to evaluate the influence on cost-effectiveness of the most relevant variables, together with a probabilistic sensitivity analysis to assess the robustness of the results. RESULTS: The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. SSA was €93,070/QALY. The ICER of pasireotide vs. SSA was €555,600/QALY. ICER was mainly driven by the incremental efficacy (4.41 QALYs for pegvisomant vs. AAS and 0.71 QALYs for pasireotide vs. AAS), with a similar increase in costs (€410,000 for pegvisomant vs. AAS and €396,000 for pasireotide vs. AAS). Using lanreotide instead of octreotide and reducing the discount rate decreased the ICER in both cases. In contrast, increasing pegvisomant and pasireotide doses and reducing the time horizon lead to an increase in the ICER. CONCLUSIONS: The ICER of pasireotide compared to SSA was six times higher than the ICER of pegvisomant compared to SSA. Therefore, pegvisomant is the most cost-effective second line alternative in the treatment of acromegaly in SSA-resistant patients for the Spanish NHS.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PSY75
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Rare and Orphan Diseases