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

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

doi:10.3747/co.21.1327

Cited by 40 publications

(11 citation statements)

References 17 publications

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“…Similar sources [29–31] were used for the coefficients of the sAEs that were not reported in the Lloyd et al (2006) study [28]. For each combination of treatments, disutility for adverse events was calculated as the weighted sum of the treatment-related sAEs observed among at least 5 % of patients in each trial and their associated disutilities.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States

Diaby

Adunlin

Ali

et al. 2016

Breast Cancer Res Treat

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Purpose Based on available phase III trial data, we performed a cost-effectiveness analysis of different treatment strategies that can be used in patients with newly diagnosed HER2-positive metastatic breast cancer (mBC). Patients and Methods We constructed a Markov model to assess the cost-effectiveness of four different HER2 targeted treatment sequences in patients with HER2-positive mBC treated in the U.S. The model followed patients weekly over their remaining life expectancies. Health states considered were progression free survival (PFS) 1st to 3rd lines, and death. Transitional probabilities were based on published phase III trials. Cost data (2015 US dollars) was captured from the U.S. Centers for Medicare and Medicaid Services (CMS) drug payment table and physician fee schedule. Health utility data were extracted from published studies. The outcomes considered were PFS, OS, costs, QALYs, the incremental cost per QALY gained ratio, and the net monetary benefit. Deterministic and probabilistic sensitivity analyses assessed the uncertainty around key model parameters and their joint impact on the base-case results. Results The combination of trastuzumab, pertuzumab, and docetaxel (THP) as first-line therapy, trastuzumab emtansine (T-DM1) as second-line therapy, and lapatinib/capecitabine third-line resulted in 1.81 QALYs, at a cost of $335,231.35. The combination of trastuzumab/docetaxel as first line without subsequent T-DM1 or pertuzumab yielded 1.41 QALYs, at a cost of $175,240.69. The least clinically effective sequence (1.27 QALYs), but most cost-effective at a total cost of $149,250.19, was trastuzumab/docetaxel as first-line therapy, T-DM1 as second-line therapy, and trastuzumab/lapatinib as third line therapy. Conclusion Our results suggest that THP as first-line therapy, followed by T-DM1 as second-line therapy, would require at least a 50% reduction in the total drug acquisition cost for it to be considered a cost-effective strategy.

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Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States

Diaby

Adunlin

Ali

et al. 2016

Breast Cancer Res Treat

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“…Both FOLFIRINOX and GNP showed consistent cost-effectiveness and cost-utility with superior survival efficacy in independent analytical studies[31,32]. However, it is not until recently that the values of each regimen were compared.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Dilemma of first line regimens in metastatic pancreatic adenocarcinoma

Ghosn¹,

Ibrahim²,

Assi³

et al. 2016

WJG

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Pancreatic cancer is one of the deadliest cancers, ranking fourth among cancer-related deaths. Despite all the major molecular advances and treatment breakthroughs, mainly targeted therapies, the cornerstone treatment of metastatic pancreatic cancer (mPC) remains cytotoxic chemotherapy. In 2016, more than 40 years after the introduction of gemcitabine in the management of mPC, the best choice for first-line treatment has not yet been fully elucidated. Two main strategies have been adopted to enhance treatment efficacy. The first strategy is based on combining non-cross resistant drugs, while the second option includes the development of newer generations of chemotherapy. More recently, two new regimens, FOLFIRINOX and gemcitabine/nab-paclitaxel (GNP), have both been shown to improve overall survival in comparison with gemcitabine alone, at the cost of increased toxicity. Therefore, the best choice for first line therapy is a matter of debate. For some authors, FOLFIRINOX should be the first choice in patients with an Eastern Cooperative Oncology Group score (0-1) given its lower hazard ratio. However, others do not share this opinion. In this paper, we review the main comparison points between FOLFIRINOX and GNP. We analyze the two pivotal trials to determine the similarities and differences in study design. In addition, we compare the toxicity profile of the two regimens as well as the impact on quality of life. Finally, we present studies revealing real life experiences and review the advantages and disadvantages of possible second-line therapies including their cost effectiveness.

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“…Many Canadian cost-effectiveness analyses in cancer have been conducted using the utility scores derived from the U.K. tariffs [28][29][30][31] and, to a lesser extent, the U.S. tariffs 32 obtained from the EQ-5D-3L. The implications of this practice of using non-Canadian tariffs have not been determined, and the Canadian Agency for Drugs and Technologies in Health has not yet made an official recommendation on this topic.…”

Section: Introductionmentioning

confidence: 99%

Impact of Country-Specific EQ-5D-3L Tariffs on the Economic Value of Systemic Therapies Used in the Treatment of Metastatic Pancreatic Cancer

Lien

Tam

et al. 2015

Current 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 40 publications

References 17 publications

Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States

Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States

Dilemma of first line regimens in metastatic pancreatic adenocarcinoma

Impact of Country-Specific EQ-5D-3L Tariffs on the Economic Value of Systemic Therapies Used in the Treatment of Metastatic Pancreatic Cancer

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