title: Cost-effectiveness analysis of pancreatin minimicrospheres in patients with pancreatic exocrine insufficiency due to chronic pancreatitis.
abstract: OBJECTIVE
  Chronic pancreatitis (CP) is the most common cause of pancreatic exocrine insufficiency (PEI). Management of PEI due to CP is achieved through lifelong treatment with pancreatic enzyme replacement therapy (PERT). To the authors' knowledge, no cost-effectiveness analysis on the benefit of PERT in CP patients with PEI has been performed to date. The objective of this analysis was to examine the cost-effectiveness of Creon (pancreatin minimicrospheres [MMS]), one of the main PERTs available in Poland, in treating patients with CP-related PEI.
  
  
  METHODS
  The cost-effectiveness of pancreatin MMS in the treatment of patients with CP-related PEI vs no PERT treatment was estimated using a decision analysis based on clinical data from relevant studies. The model horizon was 20 years. Main outcomes included the percentage of patients with controlled PEI, survival, total medical costs, number of quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). All costs were analysed from the Polish payer perspective.
  
  
  RESULTS
  The model included clinical data from 176 patients treated in five pancreatin MMS randomized trials. Treatment with pancreatin MMS resulted in a considerably higher proportion of patients with controlled PEI compared to those not treated with any PERT. Over a horizon of 20 years, the total treatment cost and the ICER for pancreatin MMS was €8223 and €6312 per QALY, respectively.
  
  
  CONCLUSIONS
  Important limitations include the lack of long-term and comparative clinical data available. The use of 'no PERT treatment' as a comparator against pancreatin MMS treatment may not accurately reflect current practice in Poland.
  
  
  CONCLUSIONS
  Treatment of CP-related PEI with pancreatin MMS is cost-effective from a Polish payer perspective, with an ICER below the accepted 'willingness to pay' threshold of 3-times gross domestic product (GDP) per capita. These results are likely to apply to other European countries.
authors.affiliation: Quintiles Consulting, Hoofddorp, The Netherlands. julia.morawski@quintiles.com
authors.forename: J H
authors.initials: JH
authors.lastname: Morawski
authors.forename: A
authors.initials: A
authors.lastname: Prüfert
authors.forename: A
authors.initials: A
authors.lastname: van Engen
authors.forename: D
authors.initials: D
authors.lastname: Foerster
authors.forename: S
authors.initials: S
authors.lastname: Sander-Struckmeier
authors.forename: E
authors.initials: E
authors.lastname: Małecka-Panas
authors.forename: R
authors.initials: R
authors.lastname: Pezzilli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy* / Q000209:etiology; D005765:Gastrointestinal Agents / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications / Q000188:drug therapy; D020799:Pancrelipase / Q000191:economics* / Q000627:therapeutic use; D011044:Poland; D012106:Research; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D020799:Pancrelipase