title: Prophylactic pasireotide administration following pancreatic resection reduces cost while improving outcomes.
abstract: OBJECTIVE
  Pasireotide decreases leak rates after pancreatic resection, though significant drug cost may be prohibitive. We conducted a cost-effectiveness analysis to determine whether prophylactic pasireotide possesses a reasonable cost profile.
  
  
  METHODS
  A cost-effectiveness model compared pasireotide administration after pancreatic resection versus usual care, populated by probabilities of clinical outcomes from a randomized trial and hospital costs (2013 US$) from a university pancreatic disease center. Sensitivity analyses were performed to identify influential clinical components of the model.
  
  
  RESULTS
  With the cost of pasireotide included, per patient costs of pancreatectomy, including those for readmission, were lower in the intervention arm (41,769 versus 42,159$; net savings of 390$, or 1%). This was associated with a 56% reduction in pancreatic fistula/pancreatic leak/abscess (PF/PL/A; 21.9-9.2%). Pasireotide cost would need to increase by over 15.4% to make the intervention strategy more costly than usual care. Sensitivity analyses exploring variability of key model inputs demonstrated that the three strongest drivers of cost were (i) cost of pasireotide; (ii) probability of readmission; and (iii) probability of PF/PL/A.
  
  
  CONCLUSIONS
  Prophylactic pasireotide administration following pancreatectomy is cost savings, reducing expensive post-operative sequealae (major complications and readmissions). Pasireotide should be utilized as a cost-saving measure in pancreatic resection. J. Surg. Oncol. 2016;113:784-788. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Jernigan
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Alex
authors.initials: A
authors.lastname: Chang
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Patrick
authors.initials: P
authors.lastname: Frye
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Schauer
authors.affiliation: Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
mesh_terms: D018784:Abdominal Abscess / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D057868:Anastomotic Leak / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004334:Drug Administration Schedule; D006728:Hormones / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs; D006801:Humans; D018803:Models, Economic; D009820:Ohio; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D013004:Somatostatin; C517782:pasireotide
keywords: cost-effectiveness; pancreatectomy; pancreatic fistula; pancreatic leak; pasireotide