Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer

Tam, Vincent C.; Ko, Yoo‐Joung; Mittmann, Nicole; Cheung, Matthew C.; Kumar, Kirushna; Hassan, Shazia; Chan, Kelvin K.

doi:10.3747/co.20.1223

Cited by 55 publications

(23 citation statements)

References 18 publications

(28 reference statements)

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“… 10 The cost is approximately 25,625 USD for one month of gemcitabine/capecitabine treatment. 15 This study showed that adjuvant therapy does not confer an overall survival benefit for patients with resected, stage IA, sub-centimeter T1a/T1b PDAC. Thus, the repercussions of therapy cost and side effects of treatment may outweigh the benefits in this group of PDAC patients.…”

Section: Discussionmentioning

confidence: 73%

Role of adjuvant therapy in resected stage IA subcentimeter (T1a/T1b) pancreatic cancer

Shaib

Narayan

Switchenko

et al. 2018

Cancer

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Objectives: Standard of care treatment for resected stage I-III pancreatic ductal adenocarcinoma (PDAC) is adjuvant gemcitabine-based chemotherapy. The role of adjuvant treatment for sub-centimeter, stage IA PDAC is unknown. This study evaluated the effect of adjuvant treatment on survival outcomes of stage IA (T1N0), resected PDAC using the National Cancer Database (NCDB). Methods: Retrospective review of the NCDB was conducted for T1 (tumor limited to pancreas, ≤2 cm in greatest dimension), node negative (N0), resected PDAC between 2004 and 2013. Patient demographics, histology, adjuvant treatment, and survival trends were examined. Kaplan-Meier analysis and log-rank tests were performed to determine unadjusted association between overall survival (OS), tumor size, and treatment. Results: A total of 876 patients met the inclusion criteria: mean age 66.2 (32–90) years; 83.3% Caucasian (N=730); 53.1% female (N=465); 45.9% moderately differentiated tumor histology (N=402); 70.0% (N=613) tumors 1–2 cm (T1c); 30.0% (N=263) <1 cm (T1a/T1b); 94.2% negative surgical margins (N=815); 46.9% (N=410) received adjuvant therapy. Median OS was significantly different for patients who received adjuvant therapy compared to patients who did not (70.7 vs. 46.9 months; P=0.0001). For patients with <1 cm tumors, survival was not significantly different between patients who received adjuvant treatment compared to those who did not (not reached vs. 85.3 months; P=0.54). In the multivariable analysis, none of the covariates (treatment group, Charlson-Deyo score, age, insurance, facility status) showed significant difference for patients with <1 cm tumors. Conclusion: This is the first report showing no survival benefit of adjuvant therapy in resected sub-centimeter PDAC.

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Section: Discussionmentioning

confidence: 73%

Role of adjuvant therapy in resected stage IA subcentimeter (T1a/T1b) pancreatic cancer

Shaib

Narayan

Switchenko

et al. 2018

Cancer

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“…The authors demonstrated that FOLFIRINOX had an 80 % probability of being cost-effective at the $100,000/QALY threshold. Another Canadian study comparing gemcitabine/erlotinib with gemcitabine had 0 % probability of being cost-effective at the same willingness to pay threshold [20]. Due to the differences in costs and healthcare systems between countries, conclusions drawn from one country cannot easily be applied to another country [21].…”

Section: Discussionmentioning

confidence: 98%

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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“…Peripheral sensory neuropathy À0.226 Assumed equal to peripheral neuropathy Peripheral neuropathy À0.226 [39] Dehydration 0.000 Assumed no reduction Asthenia À0.204 [37] Abdominal pain À0.069 [40] Nausea À0.048 [36] Diarrhea À0.261 [37] Vomiting À0.103 [41] Loss of appetite 0.000 Assumed no reduction Pulmonary embolism À0.195 [42] Pneumonia À0.440 [43] Febrile neutropenia À0.150 [41] Cholangitis À0.440 Assumed equal to event with greatest impact on quality of life Hyperbilirubinemia À0.204 Assumed equal to fatigue Nab-paclitaxel in metastatic pancreatic cancer…”

Section: Parameter Utility Sourcementioning

confidence: 99%

Cost-utility analysis of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in combination with gemcitabine in metastatic pancreatic cancer in Spain: results of the PANCOSTABRAX study

Carrato

López

Macarulla

et al. 2015

Expert Review of Pharmacoeconomics & Outcomes Research

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The PANCOSTABRAX study evaluated the cost-effectiveness of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in combination with gemcitabine (GEM) versus GEM alone in the treatment of patients with metastatic pancreatic cancer in Spain. Efficacy data were obtained from the MPACT study and were modeled to a lifetime horizon using a Markov model. The analysis was performed from the payer's perspective. Use of resources and key assumptions of the analysis were validated by a panel of oncologists. The addition of nab-paclitaxel to GEM showed higher effectiveness results (0.156 additional quality adjusted life years) at a higher cost (€6,477), resulting in a cost per quality-adjusted life years gained of €41,519. The combination of nab-paclitaxel and GEM has been shown to be an effective and well-tolerated option for the treatment of metastatic pancreatic cancer and, in addition to becoming the new standard of care, could also be considered a cost-effective option.

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Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer

Abstract: ConclusionsThe most cost-effective treatment for metastatic pancreatic cancer depends on the societal wtp threshold. If the societal wtp threshold were to be relatively high or if drug costs were to be substantially reduced, folfirinox might be cost-effective.

Cited by 55 publications

References 18 publications

Role of adjuvant therapy in resected stage IA subcentimeter (T1a/T1b) pancreatic cancer

Role of adjuvant therapy in resected stage IA subcentimeter (T1a/T1b) pancreatic cancer

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

Cost-utility analysis of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in combination with gemcitabine in metastatic pancreatic cancer in Spain: results of the PANCOSTABRAX study

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