title: Using economic analysis to evaluate the potential of multimodality therapy for elderly patients with locally advanced pancreatic cancer.
abstract: OBJECTIVE
  Development of new and expensive drugs with activity against pancreatic cancer has made economic considerations more relevant to treatment decision-making for advanced disease. Economic modeling can be used to explore the potential of such novel therapies and to inform clinical trial design.
  
  
  METHODS
  We developed a Markov model to evaluate the cost-effectiveness of radiation plus fluorouracil (RT-FU) relative to no treatment in elderly patients with locally advanced pancreatic cancer (LAPC) and to determine the economic potential of radiation plus gemcitabine (RT-GEM), a novel regimen for this disease. We used the SEER-Medicare database to estimate effectiveness and costs supplemented by data from the literature where necessary.
  
  
  RESULTS
  Relative to no treatment, RT-FU was associated with a cost-effectiveness ratio (ICER) of $68,724/QALY in the base case analysis. Compared with RT-FU, the ICER for RT-GEM was below $100,000/QALY when the risk of dying with the new regimen was <85% than with the standard regimen. However, >1,000 subjects would be necessary to demonstrate this level of efficacy in a randomized trial. The ICER of RT-GEM was most sensitive to utility values, and, at lower efficacy levels, to costs of gemcitabine and treatment-related toxicity.
  
  
  CONCLUSIONS
  In elderly patients with LAPC, RT-FU is a cost-effective alternative to no treatment. The novel regimen of RT-GEM is likely to be cost-effective at any clinically meaningful benefit, but quality-of-life issues, drug acquisition, and toxicity-related costs may be relevant, especially at lower efficacy levels.
authors.affiliation: Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. monika.krzyzanowska@uhn.on.ca
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000191:economics / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008390:Markov Chains; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine