Economic evaluation for the US of nab-paclitaxel plus gemcitabine versus FOLFIRINOX versus gemcitabine in the treatment of metastatic pancreas cancer

Gharaibeh, Mahdi; McBride, Ali; Bootman, J. Lyle; Patel, Hitendra; Abraham, Ivo

doi:10.1080/13696998.2016.1269015

Cited by 30 publications

(28 citation statements)

References 28 publications

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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%

“…8 The unit costs of managing fatigue and anemia were derived from the literature. [17][18][19][20] Each health state was assigned a health utility preference on a scale of 0 (death) to 1 (perfect health). Because the POLO trial 8 showed that EORTC Core Quality of Life Questionnaire (QLQ-C30) scores were similar between patients receiving maintenance olaparib and those receiving a placebo, we assumed that the health utility preference was only associated with the disease status.…”

Section: Cost and Utility Inputsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Cost and Utility Inputsmentioning

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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“…30 A Markov model also analyzed GnP, FOLFIRINOX, and gemcitabine as first-line treatment from an economic payer perspective in the US. 23 31 another Canadian analysis revealed FOLFIRINOX as cost effective, with an ICER below commonly quoted ICER thresholds for oncology products. Since then, the cost of oxaliplatin has considerably reduced, particularly as generic oxaliplatin is available almost worldwide.…”

Section: Benefit-risk Balance and Pharmacoeconomic Analysismentioning

confidence: 97%

“…30 A Markov model also analyzed GnP, FOLFIRINOX, and gemcitabine as first-line treatment from an economic payer perspective in the US. 23 Indirect comparisons suggest that GnP and FOLFIRINOX have statistically similar OS efficacy (HR, 0.79; 95% CI, 0.59-1.05). FOLFIRINOX prevailed in PFS efficacy (HR, 0.68; 95% CI, 0.51-0.91).…”

Section: Benefit-risk Balance and Pharmacoeconomic Analysismentioning

confidence: 99%

“…Some authors argue that different populations in the phase III pivotal trials of these combinations may have influenced more favorable results of FOLFIRINOX. 23,24 The main difference between the trials is PS in the inclusion criteria: the FOLFIRINOX trial registered patients with an ECOG PS of 0 or 1, whereas the MPACT trial allowed a Karnofsky PS of 70 corresponding to a PS of 2. 25 Patients classified as Karnofsky 70 (7.6%) 26 demonstrated a median OS of 3.9 months in the GnP group and 2.8 months in the gemcitabine group.…”

Section: First-line Regimen Options For Patients With Metastatic Pancmentioning

confidence: 99%

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Current status on the place of FOLFIRINOX in metastatic pancreatic cancer and future directions

Lambert

Gavoille

Conroy

2017

Therap Adv Gastroenterol

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Pancreatic cancer (PC) incidence rates are rapidly increasing in developed countries, with half the patients being metastatic at diagnosis. For decades, fluorouracil, then gemcitabine regimens were the preferred palliative first-line options for fit patients with metastatic PC. FOLFIRINOX (a combination of bolus and infusional fluorouracil, leucovorin, irinotecan and oxaliplatin) was introduced to clinical practice in 2010 due to the results of the phase II/III trial (PRODIGE 4/ACCORD 11) comparing FOLFIRINOX with singleagent gemcitabine as first-line treatment for patients with MPC. Median overall survival, progression-free survival, and objective response rate were superior with FOLFIRINOX over gemcitabine and there was prolonged time to definitive deterioration in quality of life. Although FOLFIRINOX was also associated with increased toxicity, mainly febrile neutropenia and diarrhea, there has been rapid uptake of this regimen. This review closely examines optimal management and prevention of toxicities, international recommendations for firstline treatment, and use of modified FOLFIRINOX protocols. In this review, we also look at the potential benefit of FOLFIRINOX in selected groups of patients: second-line therapy, adjuvant chemotherapy, induction therapy in patients with borderline resectable and locally advanced PC. Robust validation of the FOLFIRINOX regimen in these settings requires confirmation in further randomized trials.

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A multicenter propensity score analysis of FOLFIRINOX vs gemcitabine plus nab-paclitaxel administered to patients with metastatic pancreatic cancer: results from the NAPOLEON study

et al. 2021

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Economic evaluation for the US of nab-paclitaxel plus gemcitabine versus FOLFIRINOX versus gemcitabine in the treatment of metastatic pancreas cancer

Abstract: In the absence of a statistically significant difference in OS between NAB-P + GEM and FOLFIRINOX, this US analysis indicates that the greater economic benefit in terms of cost-savings and incremental cost-effectiveness and cost-utility ratios favors NAB-P + GEM over FOLFIRINOX.

Cited by 30 publications

References 28 publications

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

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

Current status on the place of FOLFIRINOX in metastatic pancreatic cancer and future directions

A multicenter propensity score analysis of FOLFIRINOX vs gemcitabine plus nab-paclitaxel administered to patients with metastatic pancreatic cancer: results from the NAPOLEON study

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