title: The Value of Survival Gains in Pancreatic Cancer from Novel Treatment Regimens.
abstract: BACKGROUND
  Metastatic pancreatic cancer (mPC) is associated with low survival, with less than 10% of patients surviving 5 years. Recent therapies improve survival outcomes where few alternative therapies exist, but few economic analyses measure the value of survival gains attributable to new therapies.
  
  
  OBJECTIVE
  To estimate the value of survival gains in advanced or mPC attributable to the introduction of novel treatment regimens.
  
  
  METHODS
  Multivariate Cox proportional hazards models were used to estimate real-world survival gains associated with the introduction of gemcitabine (GEM) for patients diagnosed with stage IV or unstaged mPC in the Surveillance, Epidemiology, and End Results Program cancer registries. Then, evidence from clinical trials was used to evaluate the survival gains associated with nab-paclitaxel + gemcitabine (nP +GEM) and FOLFIRINOX (FFX) relative to GEM. The survival estimates and clinical trial evidence were used to calibrate an economic model and assess the cumulative value of survival gains in mPC to patients. Costs of treatment were calculated based on published cost-effectiveness studies.
  
  
  RESULTS
  We estimated that the introduction of GEM in 1996 was associated with a hazard ratio of 0.920 (P < 0.05) and an increase in median survival from 3.1 to 4.5 months. Results suggested that the value of survival gains attributable to GEM equaled about $71,000 per patient, while the value attributable to nP + GEM was an additional $56,700. Estimates for the value of survival gains per patient, net of total incremental lifetime treatment costs (drugs, adverse events, and other costs), were $50,294 for GEM and an additional $31,900 for nP + GEM. Clinical trials and cost-effectiveness studies reported an overall survival gain from FFX that was larger than, but statistically similar to, nP + GEM and had greater risk of adverse events and total incremental costs. We estimated that the total value of survival gains to mPC patients, net of total costs, associated with GEM was up to $47.6 billion, and the additional values attributable to nP+GEM and FFX were up to $39.0 billion and $26.3 billion, respectively.
  
  
  CONCLUSIONS
  Historically, mPC patients have faced high disease burden and had few treatment options. Treatments introduced since 1996 have led to improved survival, with varying costs associated with treatment and adverse events. Accounting for total incremental costs, the majority of the value of survival gains from GEM and nP+GEM was retained by mPC patients, highlighting the value of innovation in settings where survival is low and few alternative therapies exist.
  
  
  BACKGROUND
  Support for this research was provided by Celgene. Precision Health Economics was compensated by Celgene for work on this study. MacEwan is an employee of, and Yin is a consultant to, Precision Health Economics. Kaura and Khan are employees of Celgene. Study concept and design were contributed primarily by Yin and MacEwan, along with Kaura and Khan. MacEwan collected the data, and data interpretation was performed primarily by MacEwan and Yin, along with Kaura and Khan. The manuscript was written and revised by MacEwan, Yin, Kaura, and Khan.
authors.affiliation: 1 Precision Health Economics, Los Angeles, California.
authors.forename: Joanna P
authors.initials: JP
authors.lastname: MacEwan
authors.affiliation: 2 University of California, Los Angeles.
authors.forename: Wes
authors.initials: W
authors.lastname: Yin
authors.affiliation: 3 Celgene, Summit, New Jersey.
authors.forename: Satyin
authors.initials: S
authors.lastname: Kaura
authors.affiliation: 3 Celgene, Summit, New Jersey.
authors.forename: Zeba M
authors.initials: ZM
authors.lastname: Khan
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000191:economics; D008297:Male; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000191:economics; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D016019:Survival Analysis; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D009944:Organoplatinum Compounds; D003841:Deoxycytidine; D017239:Paclitaxel; D002955:Leucovorin; D005472:Fluorouracil; D000093542:Gemcitabine