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

Gharaibeh, Mahdi; McBride, Ali; Alberts, David S.; Slack, Marion; Erstad, Brian L.; Alsaid, Nimer; Bootman, J. Lyle; Abraham, Ivo

doi:10.1007/s40273-018-0678-6

Cited by 10 publications

(18 citation statements)

References 22 publications

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“…A Markov model was developed to estimate the costs and treatment efficacy of metastatic pancreatic cancer and takes olaparib as a maintenance therapy compared with placebo within three mutually exclusive health states (Figure 1): "progression-free survival (PFS)" (initial state of patient until progression), "progression survival (PS)" (state after disease progression), and "death" (absorption state) (Gharaibeh et al, 2018). All patients entered the model from the PFS state; they could then either survive the PFS state or enter the PS state.…”

Section: Methods Model Structurementioning

confidence: 99%

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Cost-Effectiveness Analysis of Olaparib Maintenance Treatment for Germline BRCA-Mutated Metastatic Pancreatic Cancer

Zheng

Huang

et al. 2021

Front. Pharmacol.

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Background: The PARP inhibitor olaparib has been shown to have clinical efficacy in patients with a germline BRCA mutation and ovarian or breast cancer. However, the high treatment cost associated with this drug limits its viability as a clinical treatment option. This work aims to evaluate the cost-effectiveness of olaparib as a maintenance treatment for metastatic pancreatic cancer from the perspective of the United States and China healthcare systems and provides valuable suggestions for clinical decision making.Method: A three-state Markov model (progression-free, progressed disease, death) was constructed using TreeAge Pro 2020 software to evaluate the economic value of olaparib vs. placebo maintenance treatment for metastatic pancreatic cancer based on the clinical data derived from phase III randomized controlled trial (POLO, ClinicalTrials.gov number, NCT02184195). Total costs, quality-adjusted life years and incremental cost-effectiveness ratio were used as economic indicators for this analysis. A 5-years horizon and 5%/year discount rates were used. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were performed to assess the model uncertainty.Results: The incremental cost-effectiveness ratios (ICERs) of the use of olaparib vs. placebo in China and the United States were $6,694/QALY and $13327/QALY, respectively. All ICERs were far below the thresholds of $30829 in China and $50000 in the United States. Sensitivity analysis confirmed a stable economic advantage in the use of olaparib vs. placebo as maintenance therapy in China and the United States.Conclusion: Olaparib was estimated to be more cost effective than placebo for the maintenance therapy of patients with a germline BRCA mutation and pancreatic cancer in China and the United States at thresholds of $30829 and $50000 per QALY, respectively.

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Section: Methods Model Structurementioning

confidence: 99%

“…BSC and terminal care are necessary in all strategies because of the lack of ideal replacement therapies and the high mortality of metastatic pancreatic cancer (Wu et al, 2014;Gharaibeh et al, 2018). After progression, the cost of BSC was the only cost included in the analyses.…”

Section: Cost Estimatesmentioning

confidence: 99%

Cost-Effectiveness Analysis of Olaparib Maintenance Treatment for Germline BRCA-Mutated Metastatic Pancreatic Cancer

Zheng

Huang

et al. 2021

Front. Pharmacol.

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“…31,32 However, there is a dearth of information regarding the economic outcome of maintenance treatments for MPC. Although 2 previous economic analyses have shown that a chemotherapy regimen containing nab-paclitaxel was cost-effective in the United States and United Kingdom, 20,33,34 these analyses included treatment-naïve patients with MPC. The target populations in those studies were different from ours in that the patients we studied had received at least 16 weeks of continuous first-line platinum-based chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer

Wu¹,

Shi

2020

Journal of the National Comprehensive Cancer Network

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Background: Maintenance therapy with the PARP inhibitor olaparib for metastatic pancreatic cancer (MPC) with a germline BRCA1 or BRCA2 mutation has been shown to be effective. We aimed to evaluate the cost-effectiveness of maintenance olaparib for MPC from the US payer perspective. Materials and Methods: A partitioned survival model was adopted to project the disease course of MPC. Efficacy and toxicity data were gathered from the Pancreas Cancer Olaparib Ongoing (POLO) trial. Transition probabilities were estimated from the reported survival probabilities in each POLO group. Cost and health preference data were derived from the literature. The incremental cost-utility ratio, incremental net-health benefit, and incremental monetary benefit were measured. Subgroup analysis, one-way analysis, and probabilistic sensitivity analysis were performed to explore the model uncertainties. Results: Maintenance olaparib had an incremental cost-utility ratio of $191,596 per additional progression-free survival (PFS) quality-adjusted life-year (QALY) gained, with a high cost of $132,287 and 0.691 PFS QALY gained, compared with results for a placebo. Subgroup analysis indicated that maintenance olaparib achieved at least a 16.8% probability of cost-effectiveness at the threshold of $200,000/QALY. One-way sensitivity analyses revealed that the results were sensitive to the hazard ratio of PFS and the cost of olaparib. When overall survival was considered, maintenance olaparib had an incremental cost-utility ratio of $265,290 per additional QALY gained, with a high cost of $128,266 and 0.483 QALY gained, compared with results for a placebo. Conclusions: Maintenance olaparib is potentially cost-effective compared with placebo for patients with a germline BRCA mutation and MPC. Economic outcomes could be improved by tailoring treatment based on individual patient factors.

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“…The results were most sensitive to changes in AE management cost, base-case utility associated with PD, and utility of pancreatic cancer studies are lower than our estimates. 17,18 The reason our effectiveness estimates are higher could be due to the study population.…”

Section: Sensitivity Analysismentioning

confidence: 93%

“…Costs associated with acquiring and administering chemotherapy treatments, basic supportive care, inpatient, outpatient, pharmacy, and managing AEs were used to calculate the total costs associated with FOLFIRINOX and GemNab. [16][17][18][19] These costs were obtained from Kim et al, 16 who performed a retrospective analysis of hospital claims The effect of our assumptions on input parameters was explored with sensitivity analysis. One-way sensitivity analysis was conducted to determine the robustness of the model and to explore the influence of key input parameters.…”

Section: Model Assumptionsmentioning

confidence: 99%

Cost-effectiveness analysis of FOLFIRINOX vs gemcitabine with nab-paclitaxel as adjuvant treatment for resected pancreatic cancer in the United States based on PRODIGE-24 and APACT trials

Kharat

Nelson

et al. 2021

JMCP

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BACKGROUND: Pancreatic cancer is associated with low median overall survival. Combination chemotherapy regimens FOLFIRINOX and gemcitabine with nabpaclitaxel (GemNab) are the new adjuvant treatment standards for resectable pancreatic cancer. PRODIGE-24 and APACT trials demonstrated superior clinical outcomes with FOLFIRINOX and GemNab, each vs gemcitabine monotherapy. OBJECTIVE:To evaluate the cost-effectiveness of FOLFIRINOX vs GemNab for resectable pancreatic cancer in adults from the U.S. payer perspective, in order to inform decision makers about which of these treatments is optimal.METHODS: A Markov model with 3 disease states (relapse free, progressive disease, and death) was developed. Cycle length was 1 month, and time horizon was 10 years. Transition probabilities were derived from PRODIGE-24 and APACT survival data. All cost and utility input parameters were obtained from published literature. Costeffectiveness analysis was performed to obtain total costs, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratio (ICER). A 3% annual discount rate was applied to costs and outcomes. The effect of uncertainty on model parameters was assessed with 1-way and probabilistic sensitivity analysis (PSA).

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

Cited by 10 publications

References 22 publications

Cost-Effectiveness Analysis of Olaparib Maintenance Treatment for Germline BRCA-Mutated Metastatic Pancreatic Cancer

Cost-Effectiveness Analysis of Olaparib Maintenance Treatment for Germline BRCA-Mutated Metastatic Pancreatic Cancer

Cost-Effectiveness of Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer

Cost-effectiveness analysis of FOLFIRINOX vs gemcitabine with nab-paclitaxel as adjuvant treatment for resected pancreatic cancer in the United States based on PRODIGE-24 and APACT trials

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