Economic Evaluation for USA of Systemic Chemotherapies as First-Line Treatment of Metastatic Pancreatic Cancer
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Treatments for metastatic pancreatic cancer include monotherapy with gemcitabine (GEM); combinations of GEM with oxaliplatin (OX + GEM), cisplatin (CIS + GEM), capecitabine (CAP + GEM), or nab-paclitaxel (NAB-P + GEM); and the non-GEM combination FOLFIRINOX. Combination therapies have yielded better survival outcomes than GEM alone. A sponsor-independent economic evaluation of these regimens has not been conducted for USA.
The objective of this study was to estimate the cost utility and cost effectiveness of these regimens from the payer perspective for USA.
A three-state Markov model (progression-free, progressed disease, death) simulating the total costs and health outcomes (quality-adjusted life-years; life-years) was developed to estimate the incremental cost-utility and cost-effectiveness ratios. FOLFIRINOX clinical data were obtained from trial and indirect estimates were obtained from network meta-analyses. Lifetime horizon and 3%/year discount rates were used.
FOLFIRINOX was the most expensive regimen and GEM the least costly regimen. Compared to GEM, all but one (CIS + GEM) regimen were found to be more effective in quality-adjusted life-years and life-years. Compared to GEM, the incremental cost-utility ratios for CAP + GEM, OX-GEM, NAB-P + GEM, and FOLFIRINOX, were US$180,503, US$197,993, US$204,833, and US$265,718 per additional quality-adjusted life-year, respectively; and the incremental cost-effectiveness ratios were US$88,181, US$87,620, US$135,683, and US$167,040 per additional life-year, respectively. A probabilistic sensitivity analysis confirmed the base-case analysis.
This sponsor-independent economic evaluation for USA found that OX + GEM, CAP + GEM, FOLFIRINOX, and NAB-P + GEM, but not CIS + GEM, were more expensive but also more effective than GEM alone in terms of quality-adjusted life-years and life-years gained. The NAB-P + GEM regimen appears to be the most cost effective in USA at a willingness-to-pay threshold of US$200,000/quality-adjusted life-year.
We thank Stephanie Fletcher for her assistance in the technical preparation of the manuscript.
Concept and overall approach: MG, AM, JLB, IA. Study design: MG, IA. Interpretation of results: MG, AM, D.A, MS, BE, JLB, IA. Clinical guidance: AM, DA. Drafting of the manuscript: MG, IA. Critical review of the manuscript: AM, DA, BE, MS, JLB.
Compliance with Ethical Standards
This analysis was conducted independently and without external funding support.
Conflict of interest
Mahdi Gharaibeh, Ali McBride, David S. Alberts, Marion Slack, Brian Erstad, J. Lyle Bootman, Nimer Alsaid, and Ivo Abraham have no conflicts of interest directly relevant to the content of this article.
Data availability statement
Screenshots of the model and the calculations used to create the data are available in the electronic supplementary material.
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