title: Economic evaluation for the US of nab-paclitaxel plus gemcitabine versus FOLFIRINOX versus gemcitabine in the treatment of metastatic pancreas cancer.
abstract: BACKGROUND
  Nab-paclitaxel plus gemcitabine (NAB-P + GEM) and FOLFIRINOX have shown superior efficacy over gemcitabine (GEM) in the treatment of metastatic pancreatic ductal adenocarcinoma (mPDA). Although the incremental clinical benefits are modest, both treatments represent significant advances in the treatment of a high-mortality cancer. In this independent economic evaluation for the US, the aim was to estimate the comparative cost-utility and cost-effectiveness of these three regimens from the payer perspective.
  
  
  METHODS
  In the absence of a direct treatment comparison in a single clinical trial, the Bucher indirect comparison method was used to estimate the comparative efficacy of each regimen. A Markov model evaluated life years (LY) and quality-adjusted life years (QALY) gained with NAB-P + GEM and FOLFIRINOX over GEM, expressed as incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). All costs and outcomes were discounted at 3%/year. The impact of parameter uncertainty on the model was assessed by probabilistic sensitivity analyses.
  
  
  RESULTS
  NAB-P + GEM was associated with differentials of +0.180 LY and +0.127 QALY gained over GEM at an incremental total cost of $25,965; yielding an ICER of $144,096/LY and ICUR of $204,369/QALY gained. FOLFIRINOX was associated with differentials of +0.368 LY and +0.249 QALY gained over GEM at an incremental total cost of $93,045; yielding an ICER of $253,162/LY and ICUR of $372,813/QALY gained. In indirect comparison, the overall survival hazard ratio (OS HR) for NAB-P + GEM vs FOLFIRINOX was 0.79 (95%CI = 0.59-1.05), indicating no superiority in OS of either regimen. FOLFIRINOX had an ICER of $358,067/LY and an ICUR of $547,480/QALY gained over NAB-P + GEM. Tornado diagrams identified variation in the OS HR, but no other parameters, to impact the NAB-P + GEM and FOLFIRINOX ICURs.
  
  
  CONCLUSIONS
  In the absence of a statistically significant difference in OS between NAB-P + GEM and FOLFIRINOX, this US analysis indicates that the greater economic benefit in terms of cost-savings and incremental cost-effectiveness and cost-utility ratios favors NAB-P + GEM over FOLFIRINOX.
authors.affiliation: a Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy , University of Arizona , Tucson , AZ , USA.|b University of Arizona Cancer Center , Tucson , AZ , USA.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Gharaibeh
authors.affiliation: a Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy , University of Arizona , Tucson , AZ , USA.|b University of Arizona Cancer Center , Tucson , AZ , USA.
authors.forename: Ali
authors.initials: A
authors.lastname: McBride
authors.affiliation: a Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy , University of Arizona , Tucson , AZ , USA.
authors.forename: J Lyle
authors.initials: JL
authors.lastname: Bootman
authors.affiliation: b University of Arizona Cancer Center , Tucson , AZ , USA.
authors.forename: Hitendra
authors.initials: H
authors.lastname: Patel
authors.affiliation: a Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy , University of Arizona , Tucson , AZ , USA.|b University of Arizona Cancer Center , Tucson , AZ , USA.
authors.forename: Ivo
authors.initials: I
authors.lastname: Abraham
mesh_terms: D000418:Albumins / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D018572:Disease-Free Survival; D006801:Humans; D008390:Markov Chains; D017059:Models, Econometric; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019057:Quality-Adjusted Life Years; D014481:United States; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D003841:Deoxycytidine; D017239:Paclitaxel; D000093542:Gemcitabine
keywords: FOLFIRINOX; Metastatic disease; Pancreatic cancer; cost-effectiveness; cost-utility; gemcitabine; nab-paclitaxel