Economic Evaluation for the UK of Systemic Chemotherapies as First-Line Treatment of Metastatic Pancreatic Cancer
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Gemcitabine (GEM), oxaliplatin plus GEM (OX + GEM), cisplatin plus GEM (CIS + GEM), capecitabine plus GEM (CAP + GEM), FOLFIRINOX (FFX), and nab-paclitaxel plus GEM (NAB-P + GEM) are the most commonly used regimens as first-line treatment of metastatic pancreatic cancer (MPC) in the UK. Independent economic evaluation of these regimens simultaneously has not been conducted for the UK.
Using data from a network meta-analysis as efficacy measures, we estimated the cost effectiveness and cost utility of these regimens for the UK.
A three-state Markov model (progression-free, progressed-disease, and death) simulating the total costs and health outcomes (quality-adjusted life-years [QALYs] gained and life-years [LYs]) was developed to estimate the incremental cost-utility (ICUR) and incremental cost-effectiveness ratios (ICER) for patients with MPC, from the payer perspective. The model was specified to calculate total costs in 2017 British pounds (GBP, £). All values were discounted at 3.5% per year over a full lifetime horizon. One-way sensitivity and probabilistic sensitivity analyses were conducted to assess the impact of parameter uncertainty on the results.
FFX was the most effective regimen, NAB-P + GEM was the most costly regimen, and GEM was the least costly and least effective regimen. OX + GEM, CIS + GEM, and NAB-P + GEM were dominated by CAP + GEM and FFX. Compared with GEM, the ICUR for CAP + GEM and FFX was £28,066 and £33,020/QALY gained, respectively; compared with GEM, the ICER for CAP + GEM and FFX was £17,437 and £22,291/LY gained, respectively; and compared with CAP + GEM, the ICUR and ICER for FFX were £34,947/QALY gained and 24,414/LY gained, respectively.
At a threshold value of £30,000/QALY, CAP + GEM was found to be the only cost-effective regimen in the management of MPC in the UK.
The authors thank Stephanie Fletcher for her assistance in the technical preparation of this manuscript.
Concept and overall approach: MG, AM, JLB, NA, IA. Study design: MG, IA. Interpretation of results: MG, AM, DA, MS, BE, JLB, IA. Clinical guidance: AM, DA. Drafting of the manuscript: MG, IA. Critical review of manuscript: AM, DA, BE, MS, JLB.
Compliance with Ethical Standards
Conflict of interest
Mahdi Gharaibeh. Ali McBride, David S. Alberts, Marion Slack, Brian Erstad, J. Lyle Bootman, Nimer Alsaid, and Ivo Abraham declare no competing interests.
This analysis was conducted independently and without external funding support.
- 1.Cancer Research UK. Pancreatic cancer statistics. 2013. http://www.cancerresearchuk.org/health-professional/pancreatic-cancer-statistics. Accessed 4 Sept 2017.
- 6.Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. National Cancer Institute of Canada Clinical Trials Group. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–6.CrossRefPubMedGoogle Scholar
- 10.National Institute for Health and Care Excellence. Paclitaxel as albumin-bound nanoparticles in combination with gemcitabine for previously untreated metastatic pancreatic cancer. 2015. https://www.nice.org.uk/Guidance/GID-TAG453/Documents. Accessed 4 Sept 2017.
- 14.Colucci G, Labianca R, Di Costanzo F, Gebbia V, Cartenì G, Massidda B, et al. Gruppo Oncologico Italia Meridionale (GOIM); Gruppo Italiano per lo Studio dei Carcinomi dell’ Apparato Digerente (GISCAD); Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). Randomized phase III trial of gemcitabine plus cisplatin compared with single-agent gemcitabine as first-line treatment of patients with advanced pancreatic cancer: the GIP-1 study. J Clin Oncol. 2010;28:1645–51.CrossRefPubMedGoogle Scholar
- 16.Herrmann R, Bodoky G, Ruhstaller T, Glimelius B, Bajetta E, Schüller J, Swiss Group for Clinical Cancer Research; Central European Cooperative Oncology Group, et al. Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol. 2007;25:2212–7.CrossRefPubMedGoogle Scholar
- 18.Louvet C, Quietzsch D, Gieseler F, Gonnermann M, Schönekäs H, Rost A, et al. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol. 2005;23:3509–16.CrossRefPubMedGoogle Scholar
- 19.Poplin E, Feng Y, Berlin J, Rothenberg ML, Hochster H, Mitchell E, et al. Phase III randomized study of gemcitabine and oxaliplatin versus gemcitabine (fixed-dose rate infusion) compared with gemcitabine (30-minute infusion) in patients with pancreatic carcinoma E6201: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27:3778–85.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Latimer N. NICE DSU Technical Support Document 14: Undertaking survival analysis for economic evaluations alongside clinical trials—extrapolation with patient-level data; 2011. http://nicedsu.org.uk/wp-content/uploads/2016/03/NICE-DSU-TSD-Survival-analysis.updated-March-2013.v2.pdf. Accessed 4 Sept 2017.
- 23.Gharaibeh M, Patel H, McBride A, Bootman JL, Abraham I. Weibull and exponential proportional hazard modelling for optimizing economic evaluations of cancer treatments: FOLFIRINOX (FFX) vs gemcitabine (GEM) in metastatic pancreas cancer (mPC) [abstract no. e15704]. J Clin Oncol. 2016;34(Suppl_15):e15704.CrossRefGoogle Scholar
- 25.The British National Formulary. 2014. https://www.evidence.nhs.uk/formulary/bnf/current. Accessed 21 Apr 2018.
- 26.Department of Health. NHS reference costs 2012–2013. 2015. https://www.gov.uk/government/publications/nhs-reference-costs-2014-to-2015. Accessed 21 Apr 2018.
- 27.Personal Social Services Research Unit. Unit Costs of Health and Social Care 2015 PSSRU. 2015. http://www.pssru.ac.uk/project-pages/unit-costs/2015/. Accessed 21 Apr 2018.
- 28.United Kingdom Consumer Price Index. United Kingdom Inflation Rate. 2016. http://www.rateinflation.com/inflation-rate/uk-inflation-rate.php. Accessed 4 Sept 2017.
- 34.Romanus D, Kindler HL, Archer L, Basch E, Niedzwiecki D, Weeks J, Cancer and Leukemia Group B, et al. Does health-related quality of life improve for advanced pancreatic cancer patients who respond to gemcitabine? Analysis of a randomized phase III trial of the cancer and leukemia group B (CALGB 80303). J Pain Symptom Manage. 2012;43:205–17.CrossRefPubMedGoogle Scholar
- 36.Stainthorpe A, Greenhalgh J, Bagust A, Richardson M, Boland A, Beale S, et al. Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer: an evidence review group perspective of a NICE Single Technology Appraisal. Pharmacoeconomics. 2018. https://doi.org/10.1007/s40273-018-0646-1 (Epub 29 Mar 2018).CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Pancreatic Cancer Action. FOLFIRINOX. 2016. https://pancreaticcanceraction.org/about-pancreatic-cancer/treatment/chemotherapy/chemotherapy-drugs-for-pancreatic-cancer/folfirinox/. Accessed 4 Sept 2017.