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@ARTICLE{Holzgreve:301887,
      author       = {A. Holzgreve and L. M. Unterrainer and M. Tiling and N.
                      Mansour and C. Spitzweg and M. Brendel$^*$ and J. Ricke and
                      M. Unterrainer and W. G. Kunz and D. Mehrens},
      title        = {{C}ost-{E}ffectiveness of [177{L}u]{L}u-{DOTATATE} for the
                      {T}reatment of {N}ewly {D}iagnosed {A}dvanced
                      {G}astroenteropancreatic {N}euroendocrine {T}umors: {A}n
                      {A}nalysis {B}ased on {R}esults of the {NETTER}-2 {T}rials.},
      journal      = {Journal of nuclear medicine},
      volume       = {66},
      number       = {7},
      issn         = {0097-9058},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2025-01166},
      pages        = {1075-1081},
      year         = {2025},
      note         = {2025, 66 (7) 1075-1081},
      abstract     = {The recently published results of the NETTER-2 trial
                      suggest the use of [177Lu]Lu-DOTATATE as a new standard of
                      care in first-line therapy of patients with grade 2 or 3,
                      well-differentiated, advanced gastroenteropancreatic
                      neuroendocrine tumors. The NETTER-2 trial found superior
                      median progression-free survival (22.8 mo vs. 8.5 mo) and
                      similar adverse events and quality-of-life measures in
                      patients treated with [177Lu]Lu-DOTATATE compared with
                      octreotide long-acting release (LAR) alone. As
                      [177Lu]Lu-DOTATATE therapy is associated with higher costs,
                      we compared the cost-effectiveness of [177Lu]Lu-DOTATATE
                      with that of octreotide LAR in this setting. Methods: A
                      partitioned survival model was established for the trial
                      duration of 36 mo as well as a lifetime horizon of 20 y.
                      Progression-free survival and treatment regimens for each
                      patient group were derived from the NETTER-2 trial.
                      Information on overall survival as well as utilities for
                      health states and utilities and costs of adverse events were
                      obtained from the literature. Information on treatment costs
                      was obtained from the Centers for Medicare and Medicaid
                      Services. The willingness-to-pay threshold was set to
                      $100,000 per quality-adjusted life-year (QALY). Results:
                      [177Lu]Lu-DOTATATE was cost-effective during the trial
                      duration, with an incremental QALY of 0.13 at a slightly
                      higher cost ($8,931), leading to an incremental
                      cost-effectiveness ratio of $66,761/QALY. For the lifetime
                      analysis, [177Lu]Lu-DOTATATE dominated treatment with
                      octreotide LAR. However, deterministic sensitivity analysis
                      revealed that the incremental cost-effectiveness ratio was
                      strongly influenced by the percentage of patients treated
                      with [177Lu]Lu-DOTATATE after disease progression as well as
                      number of cycles of [177Lu]Lu-DOTATATE they received after
                      progression. In the probabilistic sensitivity analysis using
                      Monte Carlo simulation with 10,000 iterations,
                      [177Lu]Lu-DOTATATE proved to be the most cost-effective
                      strategy for 64\% of Monte Carlo iterations over the trial
                      duration. Conclusion: [177Lu]Lu-DOTATATE is cost-effective
                      as a first-line treatment for patients with grade 2 or 3,
                      well-differentiated, advanced gastroenteropancreatic
                      neuroendocrine tumors.},
      keywords     = {GEPNET (Other) / NETTER-2 (Other) / cost-effectiveness
                      analysis (Other) / neuroendocrine (Other) / oncology (Other)
                      / radionuclide therapy (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40473457},
      doi          = {10.2967/jnumed.124.269416},
      url          = {https://inrepo02.dkfz.de/record/301887},
}