title: Cost-effectiveness of everolimus vs sunitinib in treating patients with advanced, progressive pancreatic neuroendocrine tumors in the United States.
abstract: BACKGROUND
  Everolimus (Afinitor) and sunitinib (Sutent) were recently approved to treat patients with advanced, progressive pancreatic neuroendocrine tumors (pNETs). (Afinitor is a registered trademark of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; Sutent is a registered trademark of Pfizer Inc., New York, NY, USA.) This analysis examined the projected cost-effectiveness of everolimus vs sunitinib in this setting from a US payer perspective.
  
  
  METHODS
  A semi-Markov model was developed to simulate a cohort of patients with advanced, progressive pNET and to estimate the cost per life-year gained (LYG) and per quality-adjusted life-year (QALY) gained when treating with everolimus vs sunitinib. Efficacy data were based on a weight-adjusted indirect comparison of the agents using phase 3 trial data. Model health states included: stable disease with no adverse events, stable disease with adverse events, disease progression, and death. Therapy costs were based on wholesale acquisition cost. Other costs such as physician visits, tests, hospitalizations, and adverse event costs were obtained from literature and/or primary research. Utility inputs were based on primary research. Sensitivity analyses were conducted to test the model's robustness.
  
  
  RESULTS
  In the base-case analysis, everolimus was associated with an incremental 0.448 LYG (0.304 QALYs) at an incremental cost of $12,673, resulting in an incremental cost-effectiveness ratio (ICER) of $28,281/LYG ($41,702/QALY gained). The ICER fell within the cost per QALY range for many widely used oncology drugs. Sensitivity analyses demonstrated that, overall, there is a trend that everolimus is cost-effective compared to sunitinib in this setting.
  
  
  CONCLUSIONS
  Results of the indirect analysis were not statistically significant (p > 0.05). Assumptions that treatment patterns are the same across therapies may not represent real-world practice.
  
  
  CONCLUSIONS
  While the analysis is limited by its reliance on an indirect comparison of two phase 3 studies, everolimus is expected to be cost-effective relative to sunitinib in advanced, progressive pNET.
authors.affiliation: The LA-SER Group, New York, NY, USA. roman.casciano@la-ser.com
authors.forename: Roman
authors.initials: R
authors.lastname: Casciano
authors.forename: Maruit
authors.initials: M
authors.lastname: Chulikavit
authors.forename: Allison
authors.initials: A
authors.lastname: Perrin
authors.forename: Zhimei
authors.initials: Z
authors.lastname: Liu
authors.forename: Xufang
authors.initials: X
authors.lastname: Wang
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D000068338:Everolimus; D006801:Humans; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D018358:Neuroendocrine Tumors / Q000188:drug therapy* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000077210:Sunitinib; D016019:Survival Analysis; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000068338:Everolimus; D000077210:Sunitinib; D020123:Sirolimus