Cost-Effectiveness Analysis of Anamorelin and Olanzapine for Cancer Cachexia in Non-Small Cell Lung Cancer Patients...

Cancer cachexia significantly impacts quality of life and prognosis in patients with non-small cell lung cancer. Anamorelin and olanzapine have demonstrated efficacy in improving appetite and body weight in clinical trials. However, their cost-effectiveness within the Japanese healthcare system is unclear. This study assesses the cost-effectiveness of anamorelin and olanzapine for cancer cachexia in patients with non-small cell lung cancer from the perspective of Japanese healthcare payers.

A Markov model with 7 health states was developed using clinical trial data (ONO-7643-04 for anamorelin and OlAnCa for olanzapine) and real-world cost and survival data from the Japan Medical Data Center claims database. The time horizon was 60 months, with 4-week cycles (65 cycles). Costs and quality-adjusted life years (QALYs) were discounted at an annual rate of 2%. One-way and probabilistic sensitivity analyses were conducted using 1000 Monte Carlo simulations.

The incremental cost-effectiveness ratios were 7 405 419 Japanese yen (JPY)/QALY for anamorelin and 6 737 715 JPY/QALY for olanzapine compared with placebo. Both exceeded the willingness-to-pay threshold of 5 million JPY/QALY. At the 7.5 million JPY/QALY threshold, cost-effectiveness probabilities were 63.7% for anamorelin and 93.2% for olanzapine. One-way sensitivity analysis identified utility values and healthcare costs as the most influential parameters.

Both anamorelin and olanzapine exceeded conventional cost-effectiveness thresholds in Japan. Given the limitations of pharmacotherapy in improving physical function, multimodal cachexia management incorporating nutritional counselling, exercise therapy, and rehabilitation warrants consideration.