title: How Much Should We Pay to Minimize Pancreatic Leak? The Cost-effectiveness of Pasireotide in Pancreatic Resection: RETRACTED.
abstract: BACKGROUND
  Pasireotide was recently shown to decrease leak rates after pancreatic resection, though the significant cost of the drug may be prohibitive. We conducted a cost-effectiveness analysis to determine whether prophylactic pasireotide possesses a reasonable cost profile by improving outcomes.
  
  
  METHODS
  A cost-effectiveness model was constructed to compare pasireotide administration after pancreatic resection versus usual care, populated by probabilities of clinical outcomes from a recent randomized trial and hospital costs (2013 US$) from a university pancreatic disease center. Sensitivity analyses were performed to identify the most influential clinical components of the model.
  
  
  RESULTS
  Without considering pasireotide cost, prophylactic use of the drug saved an average of $8,109 per patient. However, when the cost of pasireotide was included, per patient costs increased from $42,159 to $77,202. This was associated with a 56% reduction in pancreatic fistula/pancreatic leak/abscess (PF/PL/A) (21.9% to 9.2%). The resultant cost per PF/PL/A avoided was $301,628. Threshold analysis demonstrated that for this intervention to be cost neutral, either the purchase price of pasireotide ($43,172) must be reduced by 92.3% (to $3324) or drug reimbursement must be $39,848. Sensitivity analyses exploring variable perioperative mortality, rate of PF/PL/A, and readmission rates did not significantly alter model outcomes.
  
  
  CONCLUSIONS
  Our analyses demonstrate that when prophylactic pasireotide is administered, the cost per PF/PL/A avoided is approximately $300,000. Aggressive pricing negotiation, payer reimbursement for the drug, high-volume use, and consensus among the public, payers, and surgical community regarding the value of reducing morbidity will ultimately determine the utility of widespread pasireotide application in pancreatic resection.
authors.affiliation: *Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH †Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.forename: Peter L
authors.initials: PL
authors.lastname: Jernigan
authors.forename: Alex
authors.initials: A
authors.lastname: Chang
authors.forename: Patrick
authors.initials: P
authors.lastname: Frye
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Schauer
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman