Cost-Effectiveness Analysis of Systemic Therapies in Advanced Pancreatic Cancer in the Canadian Health Care System

Value Health. 2017 Apr;20(4):586-592. doi: 10.1016/j.jval.2016.11.002. Epub 2017 Jan 3.

Abstract

Objectives: To assess the cost-effectiveness of gemcitabine (G), G + 5-fluorouracil, G + capecitabine, G + cisplatin, G + oxaliplatin, G + erlotinib, G + nab-paclitaxel (GnP), and FOLFIRINOX in the treatment of advanced pancreatic cancer from a Canadian public health payer's perspective, using data from a recently published Bayesian network meta-analysis.

Methods: Analysis was conducted through a three-state Markov model and used data on the progression of disease with treatment from the gemcitabine arms of randomized controlled trials combined with estimates from the network meta-analysis for the newer regimens. Estimates of health care costs were obtained from local providers, and utilities were derived from the literature. The model estimates the effect of treatment regimens on costs and quality-adjusted life-years (QALYs) discounted at 5% per annum.

Results: At a willingness-to-pay (WTP) threshold of greater than $30,666 per QALY, FOLFIRINOX would be the most optimal regimen. For a WTP threshold of $50,000 per QALY, the probability that FOLFIRINOX would be optimal was 57.8%. There was no price reduction for nab-paclitaxel when GnP was optimal.

Conclusions: From a Canadian public health payer's perspective at the present time and drug prices, FOLFIRINOX is the optimal regimen on the basis of the cost-effectiveness criterion. GnP is not cost-effective regardless of the WTP threshold.

Keywords: Bayesian network meta-analysis; advanced pancreatic cancer; chemotherapy; cost-effectiveness analysis; economic evaluation; gemcitabine.

Publication types

  • Comparative Study

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / economics*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bayes Theorem
  • Canada
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Drug Costs*
  • Humans
  • Markov Chains
  • Models, Economic
  • Network Meta-Analysis
  • Pancreatic Neoplasms / drug therapy*
  • Pancreatic Neoplasms / economics*
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / pathology
  • Quality-Adjusted Life Years
  • Randomized Controlled Trials as Topic
  • State Medicine / economics*
  • Time Factors
  • Treatment Outcome