title: Cost-effectiveness of folfirinox for first-line treatment of metastatic pancreatic cancer.
abstract: BACKGROUND
  The accord 11/0402 trial demonstrated that folfirinox (5-fluorouracil, leucovorin, irinotecan, oxaliplatin) is significantly more efficacious than gemcitabine monotherapy in the first-line treatment of metastatic pancreatic cancer (mpc). The present study assessed the cost-effectiveness of first-line folfirinox compared with first-line gemcitabine for public payers in Canada.
  
  
  METHODS
  A Markov model simulated the movement of mpc patients from first-line treatment until death. Overall survival (os) and progression-free survival (pfs) data were derived from accord. Published utility data and Canadian costs were applied based on time in each health state and on treatment-related adverse event (ae) rates. Costs included first- and second-line therapy, monitoring, and costs to treat aes. Two separate analyses were performed. Analysis 1 was based on trial data [first-line folfirinox followed by second-line gemcitabine compared with first-line gemcitabine followed by second-line platinum-based chemotherapy, with use of granulocyte colony-stimulating factor (g-csf) allowed], and analysis 2 used Ontario treatment patterns before folfirinox funding (first-line folfirinox followed by second-line gemcitabine compared with first-line gemcitabine followed by best supportive care, no use of g-csf).
  
  
  RESULTS
  Compared with first-line gemcitabine, first-line folfirinox resulted in more life-years and quality adjusted life-years (qalys). Probabilistic sensitivity analysis results showed that, for analyses 1 and 2 respectively, folfirinox has a greater than 85% probability and an approximately 80% probability of being cost-effective at the $100,000 threshold.
  
  
  CONCLUSIONS
  Compared with gemcitabine, first-line folfirinox significantly prolongs median os. Given the favourable cost per qaly, the improvement in clinical efficacy, and the limited available treatment options, folfirinox represents an attractive cost-effective treatment for mpc.
authors: Cornerstone Research Group Inc., Burlington, ON.
authors: C L
authors: CL
authors: Attard
authors: Cornerstone Research Group Inc., Burlington, ON.
authors: S
authors: S
authors: Brown
authors: Sanofi Canada, Laval, QC.
authors: K
authors: K
authors: Alloul
authors: Princess Margaret Hospital, Toronto, ON.
authors: M J
authors: MJ
authors: Moore
keywords: accord trial; chemotherapy; cost-effectiveness; folfirinox; gemcitabine; pancreatic cancer; qaly; quality-adjusted life year