Cost-effectiveness analysis of pancreatic enzyme replacement therapy in patients with pancreatic exocrine insufficiency in China

Background:
Pancreatic exocrine insufficiency (PEI) leads to fat malabsorption and maldigestion and is most commonly treated with pancreatic enzyme replacement therapy (PERT). Patients suffering from PEI in China are more likely not to receive adequate treatment as this drug is not part of the Chinese national essential medicine list.

Aim:
To examine the cost-effectiveness of PERT for patients suffering from PEI in China.

Methods:
A decision analytical Markov model was constructed to simulate the progress of patients with PEI in China. The population included in the analyses were patients suffering from PEI with advanced (non-resectable) pancreatic cancer, who have undergone surgery due to pancreatic cancer and who have undergone endoscopic treatment due to chronic pancreatitis. The cost-effectiveness analyses were undertaken from a Chinese societal perspective comparing PERT with no PERT. The incremental cost-effectiveness ratio in United States dollars per quality adjusted life year (QALY) gained is the main outcome. Input was informed by publicly available data supplemented with expert clinical advice.

Results:
The cost-effectiveness analyses estimated that PERT resulted in additional 0.45 to 2.93 QALYs at discounted costs of between 4315 dollars to 15193 dollars. This resulted in an incremental cost-effectiveness ratio of 5178 dollars to 9533 dollars per QALY. The one-way sensitivity analyses showed that the main drivers of the model were the cost of PERT and overall survival.

Conclusion:
This study demonstrates that PERT is a cost-effective treatment for patients suffering from PEI in China.