Real-world cost-effectiveness of first-line gemcitabine + nab-paclitaxel versus FOLFIRINOX in patients with advanced pancreatic cancer. Issue 4 (27th June 2022) - Arciero, Vanessa
Abstract: Background: There are no randomized control trials (RCTs) comparing gemcitabine and nab-paclitaxel (Gem-Nab) and FOLFIRINOX for advanced pancreatic cancer (APC). While it is well known that RCT-based efficacy often does not translate to real-world effectiveness, there is limited literature investigating comparative cost-effectiveness of Gem-Nab versus FOLFIRINOX for APC. We aimed to examine the real-world cost-effectiveness of Gem-Nab versus FOLFIRINOX for APC in Ontario, Canada. Methods: This study compared patients treated with first-line Gem-Nab or FOLFIRINOX for APC in Ontario from 04/15–03/19. Patients were linked to administrative databases. Using propensity scores and a stabilizing weights method, an inverse probability of treatment weighted cohort was developed. Mean survival and total costs were calculated over a 5-year time horizon, adjusted for censoring, and discounted at 1.5%. Incremental cost-effectiveness ratio and net monetary benefit were computed to estimate cost-effectiveness from the public healthcare payer's perspective. Sensitivity analysis was conducted using the propensity score matching method. Results: 1, 988 patients were identified (Gem-Nab: n = 928, FOLFIRINOX: n = 1, 060). Mean survival was lower for patients in the Gem-Nab than the FOLFIRINOX group (0.98 versus 1.26 life-years, incremental -0.28). Patients in the Gem-Nab group incurred greater mean 5-year total costs (Gem-Nab: $103, 884, FOLFIRINOX: $101, 518). Key cost contributors include ambulatory cancer care, acute in-patient hospitalization, and systemic therapy drug acquisition. Gem-Nab was dominated by FOLFIRINOX, as it was less effective and more costly. Results from the sensitivity analysis were similar. Conclusions: Gem-Nab is likely more costly and less effective than FOLFIRINOX, therefore not considered cost-effective at commonly accepted willingness-to-pay thresholds.