Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer.

Abstract

BACKGROUND:

There are no randomized control trials (RCTs) comparing gemcitabine and nab-paclitaxel (Gem-Nab) and fluorouracil, folinic acid, irinotecan, oxaliplatin (FOLFIRINOX) for advanced pancreatic cancer (APC). Although it is well known that RCT-based efficacy often does not translate to real-world effectiveness, there is limited literature investigating comparative cost-effectiveness of Gem-Nab vs FOLFIRINOX for APC. We aimed to examine the real-world cost-effectiveness of Gem-Nab vs FOLFIRINOX for APC in Ontario, Canada.

METHODS:

This study compared patients treated with first-line Gem-Nab or FOLFIRINOX for APC in Ontario from April 2015 to March 2019. Patients were linked to administrative databases. Using propensity scores and a stabilizing weights method, an inverse probability of treatment weighted cohort was developed. Mean survival and total costs were calculated over a 5-year time horizon, adjusted for censoring, and discounted at 1.5%. Incremental cost-effectiveness ratio and net monetary benefit were computed to estimate cost-effectiveness from the public health-care payer's perspective. Sensitivity analysis was conducted using the propensity score matching method.

RESULTS:

A total of 1988 patients were identified (Gem-Nab: n = 928; FOLFIRINOX: n = 1060). Mean survival was lower for patients in the Gem-Nab than the FOLFIRINOX group (0.98 vs 1.26 life-years; incremental effectiveness = -0.28 life-years [95% confidence interval = -0.47 to -0.13]). Patients in the Gem-Nab group incurred greater mean 5-year total costs (Gem-Nab: $103 884; FOLFIRINOX: $101 518). Key cost contributors include ambulatory cancer care, acute inpatient hospitalization, and systemic therapy drug acquisition. Gem-Nab was dominated by FOLFIRINOX, as it was less effective and more costly. Results from the sensitivity analysis were similar.

CONCLUSIONS:

Gem-Nab is likely more costly and less effective than FOLFIRINOX and therefore not considered cost-effective at commonly accepted willingness-to-pay thresholds.

• Authors: Vanessa Arciero, Jin Luo, Ambica Parmar, Wei Fang Dai, Jaclyn M Beca, Michael J Raphael, Wanrudee Isaranuwatchai, Steven Habbous, Mina Tadrous, Craig C Earle, Jim J Biagi, Nicole Mittmann, Jessica Arias, Scott Gavura, Kelvin K W Chan
• Journal: JNCI cancer spectrum (JNCI Cancer Spectr) Vol. 6 Issue 4 (07 01 2022) ISSN: 2515-5091 [Electronic] England
• PMID: 35758620 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2022. Published by Oxford University Press.

Chemical References

• 130-nm albumin-bound paclitaxel
• Albumins
• folfirinox
• Oxaliplatin
• Deoxycytidine
• Irinotecan
• Paclitaxel
• Leucovorin
• Fluorouracil
• Gemcitabine

Topics

• Albumins
• Antineoplastic Combined Chemotherapy Protocols
• Cost-Benefit Analysis
• Deoxycytidine (analogs & derivatives)
• Fluorouracil (therapeutic use)
• Humans
• Irinotecan (therapeutic use)
• Leucovorin (therapeutic use)
• Ontario (epidemiology)
• Oxaliplatin (therapeutic use)
• Paclitaxel
• Pancreatic Neoplasms (drug therapy)
• Gemcitabine
• Pancreatic Neoplasms