Comparing the cost-effectiveness of FOLFIRINOX, nab-paclitaxel plus gemcitabine, gemcitabine and S-1 for the treatment of metastatic pancreatic cancer

Abstract

Abstract. The recommended chemotherapy regimens for pancreatic cancer include the combination of 5-fluorouracil/ leucovorin, oxaliplatin and irinotecan (FOLFIRINOX), nab-paclitaxel (nab-PTX) plus gemcitabine (GEM), GEM alone and tegafur/gimeracil/oteracil potassium (S-1) alone. Although the cost-effectiveness of metastatic pancreatic cancer chemotherapies has been extensively investigated, to the best of our knowledge, no study has specifically compared the cost-effectiveness among FOLFIRINOX, nab-PTX + GEM, GEM and S-1 regimens to date. The aim of the present study was to examine the cost-effectiveness of these four regimens. The expected costs were calculated based on data from patients with metastatic pancreatic cancer who were treated with the FOLFIRINOX, nab-PTX + GEM, GEM alone or S-1 alone. The median survival time (MST) from randomized controlled trials in the literature was used to evaluate the therapeutic effect of these regimens. The cost-effectiveness ratio was calculated using expected costs and MST for these four regimens. The expected costs per patient for the FOLFIRINOX, nab-PTX + GEM, GEM or S-1 regimens were ¥6,361,191.4, ¥4,802,063.6, ¥540,091.4 and ¥528,514.6, respectively, and the cost-effectiveness ratios per mont h wer e ¥ 6 42, 5 4 4. 6/ M ST, ¥ 470,79 0. 5/ M ST, ¥81,832.0/MST and ¥55,633.1/MST, respectively. In conclusion, the nab-PTX + GEM and FOLFIRINOX regimens were associated with a high therapeutic efficacy and high cost. The GEM regimen exhibited a lower therapeutic efficacy compared with the nab-PTX + GEM and FOLFIRINOX regimens, but the findings of this study indicated that the GEM and S-1 regimens were the most cost-effective regimens. IntroductionThe recommended chemotherapy regimens for pancreatic cancer include the combination of 5-fluorouracil (5-FU)/leucovorin (FU/LV), oxaliplatin and irinotecan (FOLFIRINOX), nab-paclitaxel (nab-PTX) plus gemcitabine (GEM), GEM alone and tegafur/gimeracil/oteracil potassium (S-1) alone. The FOLFIRINOX and nab-PTX+GEM regimens have shown a particularly high effectiveness in the treatment of pancreatic cancer with distant metastases (1-4). According to the guidelines of the Japan Society of Clinical Oncology, the FOLFIRINOX and nab-PTX+GEM regimens are considered to be the first choice of treatment for metastatic pancreatic cancer (5). However, when these first-choice regimens are not viable, an appropriate treatment is selected among the GEM, erlotinib plus GEM, or S-1 regimens.Chemotherapy regimens for the treatment of colon cancer, such as FU/LV + oxaliplatin/capecitabine + oxaliplatin (FOLFOX/CapeOX) ± bevacizumab, the combination of FU/LV and irinotecan (FOLFIRI) ± cetuximab, and FOLFOX ± cetuximab, have been reported to prolong survival (4-7). However, the high medical cost of these treatments has often been discussed (8). There are similar concerns regarding the cost of future pancreatic cancer chemotherapies. Although the cost-effectiveness of metastatic pancreatic cancer chemotherapies has been previously investigated (9-13), to th...

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

“…The total effectiveness (ie, QALY and LY) for both Gharaibeh et al metastatic our study findings are similar to previous studies by Gharaibeh et al, Zhoul et al, and Kurimoto et al, who found GemNab to be cost-effective compared with FOLFIRINOX in metastatic pancreatic cancer. [17][18][19]31,32 The total cost in our study was $99,668 and $58,837 for FOLFIRINOX and GemNab, respectively. These estimates are slightly higher than the Gharaibeh et al study, where the estimated total costs of first-line FOLFIRINOX was $83,836 and $54,843 for GemNab.…”

Berberine Overcomes Gemcitabine-Associated Chemoresistance through Regulation of Rap1/PI3K-Akt Signaling in Pancreatic Ductal Adenocarcinoma

“…The current state of treatment for patients with PDAC involves combination chemotherapeutic regimens involving drug combinations such as FOLFIRINOX or gemcitabine with nab-paclitaxel, which are often accompanied by severe simultaneous drug toxicity and added expense [ 9 , 10 , 18 , 19 , 20 , 21 , 21 , 22 ]. Therefore, the development of optimal combination of safe and cost-effective therapeutic modalities is a major clinical challenge for treating patients with PDAC, which can help improve their survival outcomes.…”

“…The nab-paclitaxel doublet treatment has improved the OS vs. single-Gem regimen [ 10 ], as well as more recently, the triplet combination of 5-FU, irinotecan, and oxaliplatin (FOLFIRINOX) has shown improved survival outcomes in patients with PDAC [ 9 ]. However, the therapeutic benefits of these combination treatments are often compromised by the simultaneous drug toxicity, as well as added expense, which often limits their overall clinical efficacy [ 9 , 10 , 18 , 19 , 20 , 21 , 21 , 22 ]. Therefore, developing an optimal combination of safe and cost-effective therapeutic modalities is a major clinical challenge for PDAC treatment, which can facilitate improved survival outcomes in patients suffering from a lethal malignancy such as PDAC.…”

Cost-Effectiveness of Nab-Paclitaxel and Gemcitabine Versus Gemcitabine Monotherapy for Patients with Unresectable Metastatic Pancreatic Cancer in Japan

“…1 There are some strengths in our study. This is the first article on the cost-effectiveness analysis of GnP for patients with unresectable pancreatic cancer with distant metastasis in Japan that considered model-based analysis and long-term outcomes and used Japanese receipt data, although Kurimoto et al 11 reported a result of the cost-effectiveness of GnP for Japanese patients with pancreatic cancer. Because the purpose of this study was to support decision making in Japan, it was valuable to use Japanese cost data.…”

“…Kurimoto et al 11 performed trial-based cost-effectiveness analysis in Japan. They reported that S-1 (TS-1) and GnP was more cost-effective than both GnP and FOLFIRINOX.…”