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Cost-effectiveness comparison of prophylactic octreotide and pasireotide for prevention of fistula after pancreatic surgery

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Abstract

Purpose

Postoperative pancreatic fistula (POPF) is a major determinant of pancreatic surgery outcome, and prevention of POPF is a relevant clinical challenge. The aim of the present study is to compare the cost-effectiveness of octreotide and pasireotide for POPF prophylaxis.

Methods

A systematic literature review and meta-analysis and a retrospective patient cohort provided the data. Cost-effectiveness was calculated by the incremental cost-effectiveness ratio (ICER) and by decision tree modelling of hospital stay duration.

Results

Six randomised trials on octreotide (1255 patients) and one trial on pasireotide (300 patients) were included. The median POPF incidence without prophylaxis was 19.6 %. The relative risks for POPF after octreotide or pasireotide prophylaxis were 0.54 or 0.45. Octreotide prophylaxis (21 × 0.1 mg) costs were 249.69 Euro, compared with 728.84 Euro for pasireotide (14 × 0.9 mg) resulting in an ICER of 266.19 Euro for an additional 1.8 % risk reduction with pasireotide. Decision tree modelling revealed no significant reduction of median hospital stay duration if pasireotide was used instead of octreotide.

Conclusion

Prophylactic octreotide is almost as effective as pasireotide but incurs significantly fewer drug costs per case. However, the data quality is limited, because the effect of octreotide on clinically relevant POPF is unclear. Together with the lack of multicentric data on pasireotide and its effectiveness, a current off-label use of pasireotide does not appear to be justified.

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Author contributions

T.W. designed the study, performed the analysis and drafted the manuscript. B.M. and M.D. contributed to the analysis and data collection. H.K. provided data and reviewed the manuscript. J.W. helped to set up the study and reviewed the manuscript. D.H. designed the study and reviewed the manuscript.

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Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Thilo Welsch, Benjamin Müssle, Marius Distler & Jürgen Weitz

  2. Pharmacy Department, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

    Holger Knoth

  3. Faculty of Economics, TU Dresden, Dresden, Germany

    Dennis Häckl

Authors
  1. Thilo Welsch
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  2. Benjamin Müssle
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  3. Marius Distler
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  4. Holger Knoth
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  5. Jürgen Weitz
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  6. Dennis Häckl
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Corresponding author

Correspondence to Thilo Welsch.

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Funding

There was no third-party funding of the present project.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was not obtained by all included participants, since it was a retrospective study with anonymised individuals, and many of the individuals were deceased by the time of analysis. The present study was approved by the local ethical committee of the TU Dresden (decision no. 247062015) as stated in the “Methods” section.

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Welsch, T., Müssle, B., Distler, M. et al. Cost-effectiveness comparison of prophylactic octreotide and pasireotide for prevention of fistula after pancreatic surgery. Langenbecks Arch Surg 401, 1027–1035 (2016). https://doi.org/10.1007/s00423-016-1456-6

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  • DOI: https://doi.org/10.1007/s00423-016-1456-6

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