Comparing the cost-effectiveness of FOLFIRINOX, nab-paclitaxel plus gemcitabine, gemcitabine and S-1 for the treatment of metastatic pancreatic cancer

353 Background: In a recent phase III trial nab-paclitaxel (albumin-bound paclitaxel) + gemcitabine (nab-P/G) demonstrated a 1.8 month, or 27%, improvement in median overall survival (OS) (HR = 0.72, P < 0.001) vs gemcitabine (G) in first-line metastatic pancreatic cancer (mPC). nab-P/G had higher 1 year OS (35% vs 22%) and improved PFS by 1.8 months (HR = 0.69, P < 0.01). nab-P/G is the first taxane based therapy to show a significant OS improvement in a phase III mPC trial. Erlotinib + gemcitabine (E/G) has also demonstrated activity in mPC, with a 0.3 month OS benefit vs G (HR = 0.82, P = 0.04), a 1 year OS of 23% vs 17%, and 0.2 months PFS benefit (HR = 0.77, P = 0.004) vs G. A cost-effectiveness analysis measuring the cost per life year (LY) gained for nab-P/G and E/G was conducted from the US payer perspective. Methods: Costs and clinical outcomes were evaluated fromnab-P/G vs G and E/G vs G trials of mPC. Health care resource use and the management of grade III/IV adverse events (AE) were collected from a large multisite US oncology clinic, expert opinion, and literature (2012 US dollars). Drug cost per cycle was multiplied by the median cycles delivered from the trials for nab-P/G and E/G. Results: Duration of therapy was 4 months for nab-P/G vs 3.9 months for E/G. Total cost for nab-P/G was $24,984 vs $23,044 for E/G, including drug, administration and AE management. AE costs were similar between the two therapies (Table). Differences of > 5% were noted in neutropenia (rates: nab-P/G = 33%; E/G = 24%), neuropathy (nab-P/G = 17%; E/G = 1%), and rash (nab-P/G = 0%; E/G = 6%). The net survival advantage for nab-P/G vs E/G was 1.5 incremental life months gained. Nab-P/G was cost-effective relative to E/G, at a cost of $15,522 per incremental life year gained. Conclusions: nab-P/G is a cost-effective alternative to E/G in mPC, bringing more months of OS at < $16,000 cost per incremental life year gained. [Table: see text]

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Cost-Effectiveness of Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7587 ◽

2020 ◽

Vol 18 (11) ◽

pp. 1528-1536 ◽

Cited By ~ 1

Author(s):

Bin Wu ◽

Lizheng Shi

Keyword(s):

Pancreatic Cancer ◽

Cost Effectiveness ◽

Incremental Cost ◽

Subgroup Analysis ◽

Transition Probabilities ◽

Health Benefit ◽

Cost Utility ◽

Sensitivity Analyses ◽

Metastatic Pancreatic Cancer ◽

The Cost

Background: Maintenance therapy with the PARP inhibitor olaparib for metastatic pancreatic cancer (MPC) with a germline BRCA1 or BRCA2 mutation has been shown to be effective. We aimed to evaluate the cost-effectiveness of maintenance olaparib for MPC from the US payer perspective. Materials and Methods: A partitioned survival model was adopted to project the disease course of MPC. Efficacy and toxicity data were gathered from the Pancreas Cancer Olaparib Ongoing (POLO) trial. Transition probabilities were estimated from the reported survival probabilities in each POLO group. Cost and health preference data were derived from the literature. The incremental cost-utility ratio, incremental net-health benefit, and incremental monetary benefit were measured. Subgroup analysis, one-way analysis, and probabilistic sensitivity analysis were performed to explore the model uncertainties. Results: Maintenance olaparib had an incremental cost-utility ratio of $191,596 per additional progression-free survival (PFS) quality-adjusted life-year (QALY) gained, with a high cost of $132,287 and 0.691 PFS QALY gained, compared with results for a placebo. Subgroup analysis indicated that maintenance olaparib achieved at least a 16.8% probability of cost-effectiveness at the threshold of $200,000/QALY. One-way sensitivity analyses revealed that the results were sensitive to the hazard ratio of PFS and the cost of olaparib. When overall survival was considered, maintenance olaparib had an incremental cost-utility ratio of $265,290 per additional QALY gained, with a high cost of $128,266 and 0.483 QALY gained, compared with results for a placebo. Conclusions: Maintenance olaparib is potentially cost-effective compared with placebo for patients with a germline BRCA mutation and MPC. Economic outcomes could be improved by tailoring treatment based on individual patient factors.

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Cost efficiency and budget-neutral expanded access to antineoplastic therapy from cost-savings derived from conversion to biosimilar pegfilgrastim-cbqv for the prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN):Simulation modeling in metastatic pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.441 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 441-441

Author(s):

Ali McBride ◽

Karen MacDonald ◽

Ivo Abraham

Keyword(s):

Pancreatic Cancer ◽

Simulation Modeling ◽

Age Distribution ◽

Cost Savings ◽

Metastatic Pancreatic Cancer ◽

Selling Price ◽

Expanded Access ◽

Conversion Rates ◽

Insured Patients ◽

The Cost

441 Background: Biosimilars have contributed to the reduction in the cost of prophylaxis of CIN/FN in recent years. Savings generated from conversion to biosimilars could be reallocated on a budget-neutral basis to provide expanded access to additional prophylaxis or to anti-neoplastic treatment. To demonstrate this, we simulated: 1) the savings that could be realized from CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv (BIOSIM-PEG) over reference pegfilgrastim with or without on-body injector (PEG/PEG-OBI), 2) a model of expanded access to BIOSIM-PEG from cost-savings achieved from conversion from PEG/PEG-OBI, 3) a model of expanded access to chemotherapy with oxaliplatin, leucovorin, irinotecan, and fluorouracil (FOLFIRINOX) for metastatic pancreatic cancer (mPC), 4) the number-needed-to-convert (NNC) to BIOSIM-PEG to purchase one additional treatment of BIOSIM-PEG, and 5) the NNC to purchase one cycle of FOLFIRINOX. Methods: This simulation modeling from the US payer perspective utilized: 1) a blended rate of average selling price (ASP; derived from CMS Q4 2020 reimbursement) and wholesale acquisition cost (WAC; Redbook) for PEG/PEG-OBI, BIOSIM-PEG, and all FOLFIRINOX agents proportionate to the estimated 2020 incident pancreatic cancer age distribution per Surveillance, Epidemiology, and End Results Program (67.6% Medicare-insured patients ≥65 years of age; 32.4% commercially insured patients <65 years); 2) between one and twelve cycles of prophylaxis in a panel of 2,500 mPC patients treated with FOLFIRINOX; and 3) conversion rates from PEG/PEG-OBI to BIOSIM-PEG ranging from 10%—100%. Results: Using a current blended ASP/WAC rate, cost-savings of BIOSIM-PEG over PEG/PEG-OBI in a panel of 2,500 mPC patients range from $188,780 (for 1 cycle of prophylaxis at 10% conversion) to $22,653,609 (12 cycles at 100%). In a single cycle of chemotherapy, these savings translate into expanded access to additional BIOSIM-PEG prophylaxis ranging from 53 cycles at 10% conversion from PEG/PEG-OBI to 528 cycles at 100% or to between 321 to 3,214 cycles of FOLFIRINOX, respectively. The savings over twelve cycles could provide up to 6,330 additional cycles of BIOSIM-PEG or 38,571 cycles of FOLFIRINOX (at 100% conversion). The NNC from PEG/PEG-OBI to purchase one additional cycle of BIOSIM-PEG is 4.74; the NNC to purchase once cycle of FOLFIRINOX is 0.78. Conclusions: These simulated models demonstrate the magnitude of the cost savings for CIN/FN prophylaxis that can be generated by conversion to biosimilar pegfilgrastim-cbqv. Further, these savings could be reallocated to provide access to anti-neoplastic treatment on a budget-neutral basis, thus enhancing the value of cancer care to both payers and patients.

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Cost-Effectiveness Analysis Comparing FOLFIRINOX and Nab-Paclitaxel (Abaraxane) Plus Gemcitabine For First-Line Treatment Of Patients with Metastatic Pancreatic Cancer from the US Societal Perspective

Value in Health ◽

10.1016/j.jval.2016.03.1607 ◽

2016 ◽

Vol 19 (3) ◽

pp. A153

Author(s):

W Cheng ◽

JW Hay

Keyword(s):

Pancreatic Cancer ◽

Cost Effectiveness ◽

Societal Perspective ◽

Cost Effectiveness Analysis ◽

Metastatic Pancreatic Cancer ◽

Line Treatment ◽

First Line ◽

Effectiveness Analysis ◽

The Us ◽

First Line Treatment

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PCN20 Comparison of Nab-paclitaxel PLUS Gemcitabine Versus FOLFIRINOX in First LINE Treatment of Metastatic Pancreatic Cancer in China: A Cost-Effectiveness Analysis

Value in Health Regional Issues ◽

10.1016/j.vhri.2020.07.070 ◽

2020 ◽

Vol 22 ◽

pp. S7-S8

Author(s):

J. Cui ◽

X. Zhang ◽

S. Qu ◽

Y. Liu ◽

C. Ye ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cost Effectiveness ◽

Cost Effectiveness Analysis ◽

Metastatic Pancreatic Cancer ◽

Line Treatment ◽

First Line ◽

Effectiveness Analysis ◽

First Line Treatment

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Real-world assessment of healthcare costs for patients with metastatic pancreatic cancer following first-line chemotherapy initiation.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15710 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15710-e15710

Author(s):

Andrea J. Bullock ◽

Christopher G Rowan ◽

Nina Hill ◽

Homa Yeganegi ◽

E. Gabriela Chiorean

Keyword(s):

Pancreatic Cancer ◽

Healthcare Costs ◽

Metastatic Pancreatic Cancer ◽

First Line ◽

Cost Differential ◽

Time Table ◽

Chemotherapy Initiation ◽

The Cost ◽

Baseline Health

e15710 Background: Nab-paclitaxel-gemcitabine (AG) and FOLFIRINOX (FFX) are commonly used regimens for the treatment of metastatic pancreatic cancer (mPDA). This descriptive study aimed to report total healthcare costs following first line (1L) exposure to AG/FFX among patients with mPDA. Methods: Retrospective cohorts of 1L AG and FFX initiators with mPDA were constructed from the MarketScan database (study period 2014-2017). The index date was the date of 1L AG or FFX initiation. Included patients had continuous insurance enrollment. Total healthcare costs (outpatient, inpatient, emergency department, chemotherapy, pharmacy) were assessed at 0-1, 0-3, 0-6, and 0-12 months post-index among patients who remained uncensored (using the last claim date) through the last month of each follow-up interval. Results: 2199 patients initiated AG (N=1352) or FFX (N=847) as their 1L regimen. Compared with AG initiators, FFX patients were younger (59 vs 63 years) and had better baseline health status (FFX/AG): diabetes 43%/57%; cerebrovascular disease 21%/27%. Median time to censoring was 5.4 (AG) and 7.2 (FFX) months. Median treatment duration was 2.1 (AG) and 2.3 (FFX) months. FFX costs were higher than AG costs during each follow-up interval, with the cost differential increasing over time (Table). Conclusions: Higher total healthcare costs were observed for patients with mPDA who initiated 1L FFX compared with 1L AG. Further research using comparative methodology is warranted to fully elucidate these findings and understand cost drivers. [Table: see text]

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