Cost-effectiveness of FOLFIRINOX for first-line treatment of metastatic pancreatic cancer.

Attard, Cheryl; Brown, Stephen; Alloul, Karine; Moore, Malcolm J.

doi:10.1200/jco.2012.30.4_suppl.199

Cited by 17 publications

(20 citation statements)

References 10 publications

(12 reference statements)

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“…The costs associated with managing AEs during PC treatment are often considerable 23. Therefore, identification of the AE profile for real-world patients is quite relevant from an economic perspective.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and resource utilization of <em>nab</em>-paclitaxel plus gemcitabine vs FOLFIRINOX or gemcitabine for the first-line treatment of metastatic pancreatic adenocarcinoma in a US community setting

Braiteh¹,

Parisi²,

Ni³

et al. 2017

CMAR

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IntroductionDespite a clinically relevant, statistically significant survival benefit with nab-paclitaxel plus gemcitabine and FOLFIRINOX vs single-agent gemcitabine for metastatic pancreatic cancer (mPC), little is known regarding their real-world effectiveness. We analyzed patients with mPC using a nationally representative electronic medical records database to address this unmet need.MethodsThis retrospective analysis of the Navigating Cancer database compared outcomes among patients who received first-line nab-paclitaxel plus gemcitabine, FOLFIRINOX, or gemcitabine for mPC. Effectiveness, safety, and supportive care use were examined. nab-Paclitaxel plus gemcitabine was the reference for statistical comparisons.ResultsBaseline characteristics were similar except age (oldest patients were in the gemcitabine cohort followed by nab-paclitaxel plus gemcitabine, then FOLFIRINOX). Patients receiving nab-paclitaxel plus gemcitabine (n=122) demonstrated similar time to treatment discontinuation (TTD; median, 3.4 vs 3.8 months; P=0.947) and database persistence (DP; median, 8.6 vs 8.6 months; P=0.534) vs FOLFIRINOX (n=80); however, TTD (median, 3.4 vs 2.2 months; P<0.001) and DP (median, 8.6 vs 5.3 months; P=0.030) were significantly longer with nab-paclitaxel plus gemcitabine vs gemcitabine (n=46). There were more any-grade adverse events with FOLFIRINOX or gemcitabine vs nab-paclitaxel plus gemcitabine (95% or 89% vs 84%, respectively).ConclusionThis real-world analysis confirms the phase III MPACT trial findings and demonstrates that nab-paclitaxel plus gemcitabine has effectiveness similar to that of FOLFIRINOX but greater tolerability for treating mPC despite younger patients being in the FOLFIRINOX cohort. These findings support nab-paclitaxel plus gemcitabine as an appropriate first-line treatment option for patients with mPC.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and resource utilization of <em>nab</em>-paclitaxel plus gemcitabine vs FOLFIRINOX or gemcitabine for the first-line treatment of metastatic pancreatic adenocarcinoma in a US community setting

Braiteh¹,

Parisi²,

Ni³

et al. 2017

CMAR

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“…After the efficacy of gemcitabine was demonstrated in 1997, a UK study concluded that it was a cost-effective therapy [18]. A Canadian costeffectiveness evaluation compared FOLFIRINOX with gemcitabine using data from the ACCORD trial [19]. The authors demonstrated that FOLFIRINOX had an 80 % probability of being cost-effective at the $100,000/QALY threshold.…”

Section: Discussionmentioning

confidence: 96%

Cost description of chemotherapy regimens for the treatment of metastatic pancreas cancer

et al. 2016

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Multiple chemotherapy regimens are available for the treatment of metastatic pancreas cancer (mPCA). Choice of regimen is based on the patient's performance status and toxicity profile of the regimen. The objective of this study was to analyze the costs of first-line regimens to further aid in decision-making and develop a platform upon which to assess value. We calculated the monthly cost for individual standard regimens (gemcitabine, gemcitabine/nab-paclitaxel, gemcitabine/erlotinib and FOLFIRINOX) and the overall treatment cost for a course of therapy based on the median progression-free survival achieved in published studies. In addition to cost of drugs, we included administration costs and costs of toxicities (including growth factor support, blood product transfusion and hospitalization for toxicities). Costs for administration and management of adverse events were based on Medicare reimbursement rates for hospital and physician services. Drug costs were based on Medicare average sale prices (all 2014 US$). The monthly costs for gemcitabine, FOLFIRINOX, gemcitabine/erlotinib and gemcitabine/nab-paclitaxel were $1363, $7234, $8007 and $12,221, respectively. The overall treatment costs for a course of the same regimens based on median PFS were $5043, $46,298, $51,004 and $67,216, respectively. The choice of chemotherapy regimen for mPCA should be based on tolerability and efficacy of the regimen individualized to patient's performance status. Healthcare systems have finite resources; thus, there is increasing emphasis on metrics to define value in health care when outcomes of therapy are similar or produce marked differences in value. These data provide useful financial information to incorporate into the decision-making process.

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“…Society has indirectly placed a financial attribution to a quality adjusted life year (QALY), ranging from $50,000 to $150,000, depending on the source; frequently, these values reflect what Medicare will reimburse for a year of hemodialysis, or alternatively 2–3 times country‐specific per capita income . However, current chemotherapy regimens for pancreatic cancer fall both below (FOLFIRINOX) and above (Erlotinib) this threshold . But there has been no formal discussion or conclusion reached about a reasonable cost to avoid suffering.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic pasireotide administration following pancreatic resection reduces cost while improving outcomes

Abbott

Sutton

Jernigan

et al. 2016

Journal of Surgical Oncology

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Cost-effectiveness of FOLFIRINOX for first-line treatment of metastatic pancreatic cancer.

Abstract: ConclusionsCompared with gemcitabine, first-line folfirinox significantly prolongs median os. Given the favourable cost per qaly, the improvement in clinical efficacy, and the limited available treatment options, folfirinox represents an attractive cost-effective treatment for mpc.

Cited by 17 publications

References 10 publications

Comparative effectiveness and resource utilization of <em>nab</em>-paclitaxel plus gemcitabine vs FOLFIRINOX or gemcitabine for the first-line treatment of metastatic pancreatic adenocarcinoma in a US community setting

Comparative effectiveness and resource utilization of <em>nab</em>-paclitaxel plus gemcitabine vs FOLFIRINOX or gemcitabine for the first-line treatment of metastatic pancreatic adenocarcinoma in a US community setting

Cost description of chemotherapy regimens for the treatment of metastatic pancreas cancer

Prophylactic pasireotide administration following pancreatic resection reduces cost while improving outcomes

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