Cost-effectiveness of systematic chemotherapy for metastatic pancreatic cancer: a retrospective study using Japanese clinical data

Abstract Background: Gemcitabine plus nab-paclitaxel (GnP)and modified FOLFIRINOX (mFFX)are recommended as standard first-line treatments for metastatic pancreatic cancer in Japan. Considering the emergence and associated costs of adverse events in clinical practice, it is unclear which treatment is more cost-effective: mFFX or GnP. This study aimed to evaluate the cost-effectiveness of mFFX and GnPin patients with metastaticpancreatic cancer in clinical practice in Jaan. Methods: This retrospective cohort study compared patients with metastatic pancreatic cancer treated with mFFX or GnP between December 2013 and February 2017 at the National Cancer Center Hospital East. A partitioned survival model was developed featuring five mutually exclusive health states, namely, 1st line stable disease (1stSD), 1st progressive disease (1stPD), 2nd line stable disease (2ndSD), 2nd progressive disease (2ndPD), and death. A cost-effectiveness analysis was performed to obtain the total costs and quality-adjusted life-years (QALYs). A 2% annual discount rate was applied to costs and outcomes. A one-way sensitivity analysis(OWSA) was performed to assess the effect of parameter uncertainty on the results. mFFX treatment involved the intravenous infusion of oxaliplatin, levofolinate, and irinotecan, while GnP treatment involved weekly intravenous administration of nab-paclitaxel and gemcitabine. Dosages were adjusted based on observed adverse events. Results: The total costs of the mFFX and GnP arms were JPY 3,193,597 (USD 31,006) and JPY 3,913,171 (USD 37,992), respectively. Incremental total costs of JPY 719,574 (USD 6,986) were associated with GnP compared to mFFX. Total QALYs in the mFFX and the GnP arms were 0.427 and 0.435, respectively. Conclusion: GnP was associated with slightly higher QALYs than mFFX in Japanese clinical practice and should be the preferred first-line treatment for metastatic pancreatic cancer in Japan.