ArticleESMO gastrointestinal oncology2026
Cost savings associated with the adoption of lower-dose everolimus in patients with advanced neuroendocrine tumors.
Article in ESMO gastrointestinal oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Everolimus is effective in advanced neuroendocrine tumors (NETs) but is associated with substantial toxicity and high long-term costs. Real-world data suggest that lower doses (≤6 mg/day) achieve comparable efficacy with reduced toxicity compared with standard-dose therapy. This study aimed to quantify the cost savings associated with a lower-dose everolimus strategy in a middle-income country setting. Materials and methods: We conducted a retrospective microcosting analysis from the Brazilian private provider perspective using patient-level data from two referral centers. Adults with advanced, well-differentiated NET who received everolimus were stratified by mean daily dose: high-dose (HD, >6 mg; Results: Seventy-five patients were included (HD = 61; LD = 14). The mean length of time using everolimus was 41 months (HD) and 35 months (LD). Drug acquisition accounted for 91% of total expenditure, while hospitalizations accounted for 9%. Direct mean monthly cost was US$2696 [standard deviation (SD) 2032] in the HD group versus US$1558 (SD 144) in the LD group (42% lower; Conclusion: In a real-world Brazilian cohort, with previous evidence suggesting no compromise in efficacy, lower-dose everolimus (≤6 mg/day) was associated with a potential cost saving of US$1137 per patient-month in patients with advanced NET, reflecting a 46% decrease in cost. Deliberate dose optimization strategies can substantially improve the affordability and sustainability of NET care, particularly in resource-constrained settings.
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