title: Cost-effectiveness of Gemcitabine Plus Modern Radiotherapy in Locally Advanced Pancreatic Cancer.
abstract: The purpose of this study was to evaluate the cost-effectiveness of gemcitabine plus modern radiotherapy versus gemcitabine alone in the treatment of locally advanced pancreatic cancer in Taiwan.
  
  
  
  A Markov decision-analytic model was performed to compare the cost-effectiveness of 3 treatment regimens; gemcitabine alone (gem-alone), gemcitabine plus intensity-modulated radiotherapy (gem-IMRT), and gemcitabine plus stereotactic body radiotherapy (gem-SBRT). Patients transitioned between 5 health states: stable disease, local progression, distant metastasis, local and distant metastasis, and death.
  
  
  
  The incremental cost-effectiveness ratio for gem-IMRT and gem-SBRT compared with gem-alone were NT$27,120,168 and NT$2,145,683 per quality-adjusted life-year gained, respectively. A willingness to pay threshold of 3 times the per capita gross domestic product was adopted according to the definition of the World Health Organization. The Taiwan per capita gross domestic product in 2015 was NT$673,920 (US$22,464; 1 NT$ = US$0.03333 in Taiwan); thus, a threshold was considered as NT$2,021,760 (US$67,392). The Monte-Carlo simulation found that the probability of cost-effectiveness at a willingness to pay threshold of NT$2,021,760 per quality-adjusted life-year was 0% chance for gem-IMRT and 50% for gem-SBRT.
  
  
  
  This study indicated that gem-IMRT or gem-SBRT in locally advanced pancreatic cancer is not cost-effective at a willingness to pay as defined by World Health Organization guideline in Taiwan.
authors.affiliation: Department of Radiation Therapy, An Nan Hospital, China Medical University, Tainan, Taiwan; Department of Information Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan.
authors.forename: Henry W C
authors.initials: HW
authors.lastname: Leung
authors.affiliation: Department of Pharmacy, An-Nan Hospital, China Medical University, Tainan, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan. Electronic address: agnes.lf@gmail.com.
authors.forename: Agnes L F
authors.initials: AL
authors.lastname: Chan
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
mesh_terms: D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D018450:Disease Progression; D006801:Humans; D009010:Monte Carlo Method; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics / Q000379:methods*; D013624:Taiwan; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D000093542:Gemcitabine
keywords: cost-effectiveness; economic evaluation; locally advanced pancreatic cancer; stereotactic body radiotherapy