Annals of Surgery

Bookfiler & Everyone,

If you get a chance at IRE take it. And, give this forum more time.

Regarding Pasireotide, as you will understand, one should not make a decision on this drug solely because of comments in a forum. Pasireotide’s benefits are acknowledged favorable on page 73 of the new NCCN Pancreatic Adenocarcinoma guidelines, available by means of a free subscription at

Its cost may account for its infrequent use, approximately $50,000 per patient. If a fistula/abscess is avoided, the medical savings is $300,000. See

To use the drug most effectively is must be administered prophylactic, that is, before a fistula/abscess develops. But, not all pancreatic resections are destined to result in fistula/abscess. That is the cost problem – a great expense for each patient, but not all patients will need it.

However, our lesson is: If you can afford the drug or get it covered by insurance, take advantage of it – as you can imagine the medical savings (above) do not include the value of a life saved.

PhilipJax

Annals of Surgery:

Post Author Corrections: November 26, 2015

doi: 10.1097/SLA.0000000000001411

Original Article: PDF Only

How Much Should We Pay to Minimize Pancreatic Leak? The Cost-effectiveness of Pasireotide in Pancreatic Resection: RETRACTED.

Abbott, Daniel E. MD; Sutton, Jeffrey M. MD; Jernigan, Peter L. MD; Chang, Alex MD; Frye, Patrick MBA; Shah, Shimul A. MD; Schauer, Daniel P. MD; Eckman, Mark H. MD; Ahmad, Syed A. MD; Sussman, Jeffrey J. MD

Published Ahead-of-Print

Abstract

Introduction: 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.