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Does giving pasireotide to patients undergoing pancreaticoduodenectomy always pay for itself?

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Summary

Background

Previous cost evaluation studies reported either no increase or cost-saving using pasireotide in patients undergoing pancreaticoduodenectomy. We examined the likelihood and magnitude of cost-saving when using pasireotide at our institution to determine the generalizability of prior reports.

Methods

Cost data were obtained for a cohort of 440 patients undergoing pancreaticoduodenectomy at a single institution during 2009–2016. A statistical model was used to simulate the cost of patient care had they received pasireotide. Sensitivity analyses were performed to assess the impact of pasireotide price and pancreatic fistula rate on cost.

Results

With a fistula rate of 10.2% and a current price for pasireotide of $1257, the likelihood of cost-saving is 60%. When cost-saving does occur, the mean cost-saving per patient is $1442, 2.5–97.5% quantile difference (QD): $69–3756. At the same pasireotide price but with a fistula rate of 30%, the likelihood of cost-saving increases to 91% with a mean cost-saving of $4030, 2.5–97.5% QD: $402–8511. At the same fistula rate but with a pasireotide price of $1000, the likelihood of cost-saving increases to 65% with a cost-saving of $1566, 2.5–97.5% QD: $75–3979.

Conclusion

At its current price, and with the fistula rate at our institution, pasireotide is more likely to pay for itself than not, but there is a significant probability that it will not be cost-saving. Negotiating a better price (i.e., to the lowest found in the literature) will reduce the likelihood of pasireotide not being cost-saving by 5%.

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Author information

Authors and Affiliations

  1. School of Medicine, University of Virginia, Charlottesville, VA, USA

    Fang Yuan MD

  2. Department of Health Research Methods, Evaluation and Impact, McMaster University, Hamilton, Ontario, Canada

    Amiram Gafni PhD & Pablo E. Serrano MD MSc

  3. Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

    Amiram Gafni PhD

  4. Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario, Canada

    Chu-Shu Gu PhD

  5. Department of Surgery, McMaster University, Hamilton, Ontario, Canada

    Pablo E. Serrano MD MSc

  6. Juravinski Hospital and Cancer Centre, 711 Concession St. B3-161, L8V 1C3, Hamilton, ON, Canada

    Pablo E. Serrano MD MSc

Authors
  1. Fang Yuan MD
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  2. Amiram Gafni PhD
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  3. Chu-Shu Gu PhD
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  4. Pablo E. Serrano MD MSc
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Corresponding author

Correspondence to Pablo E. Serrano MD MSc.

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Conflict of interest

F. Yuan, A. Gafni, C.-S. Gu, and P.E. Serrano declare that they have no competing interests.

Ethical standards

As part of our institutional Research Ethics Board submission, a waiver of consent was approved for this retrospective chart review.

Additional information

Presentations

This work was presented in part at: SSAT, Chicago, Illinois, May 9, 2017 and Pancreas Club, Chicago, Illinois, May 5, 2017.

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Table S1: Characteristics of patients with or without pancreatic fistula

10353_2018_563_MOESM2_ESM.docx

Table S2: Market price of 14 doses of pasireotide and the price after converting into Canadian currency from 14 different countries/regions according to hospital pricing

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Yuan, F., Gafni, A., Gu, CS. et al. Does giving pasireotide to patients undergoing pancreaticoduodenectomy always pay for itself?. Eur Surg 52, 132–140 (2020). https://doi.org/10.1007/s10353-018-0563-8

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  • DOI: https://doi.org/10.1007/s10353-018-0563-8

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