Economic Evaluation for USA of Systemic Chemotherapies as First-Line Treatment of Metastatic Pancreatic Cancer

Mahdi Gharaibeh, Ali McBride, David S. Alberts, Marion Slack, Brian Erstad, Nimer Alsaid, J. Lyle Bootman and Ivo Abraham ()
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Mahdi Gharaibeh: University of Arizona
Ali McBride: University of Arizona Cancer Center
David S. Alberts: University of Arizona Cancer Center
Marion Slack: University of Arizona
Brian Erstad: University of Arizona
Nimer Alsaid: University of Arizona
J. Lyle Bootman: University of Arizona
Ivo Abraham: University of Arizona

PharmacoEconomics, 2018, vol. 36, issue 10, No 9, 1273-1284

Abstract: Abstract Background 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. Objective The objective of this study was to estimate the cost utility and cost effectiveness of these regimens from the payer perspective for USA. Methods 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. Results 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. Conclusions 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.

Date: 2018
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DOI: 10.1007/s40273-018-0678-6

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