Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer

被引：7

作者：

Arciero, Vanessa ^{[1
,2
]}

Luo, Jin ^{[3
]}

Parmar, Ambica ^{[1
,2
]}

Dai, Wei Fang ^{[2
,4
]}

Beca, Jaclyn M. ^{[4
,5
]}

Raphael, Michael J. ^{[1
,2
]}

Isaranuwatchai, Wanrudee ^{[4
,6
]}

Habbous, Steven ^{[5
]}

Tadrous, Mina ^{[7
]}

Earle, Craig C. ^{[1
,2
,8
]}

Biagi, Jim J. ^{[9
]}

Mittmann, Nicole ^{[10
]}

Arias, Jessica ^{[5
]}

Gavura, Scott ^{[5
]}

Chan, Kelvin K. W. ^{[1
,2
,4
,5
]}

机构：

[1] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Div Med Oncol, Toronto, ON, Canada

[2] Univ Toronto, Temerty Fac Med, Toronto, ON, Canada

[3] ICES, Toronto, ON, Canada

[4] Canadian Ctr Appl Res Canc Control, Toronto, ON, Canada

[5] Canc Care Ontario, Ontario Hlth, Toronto, ON, Canada

[6] Univ Toronto, St Michaels Hosp, Toronto, ON, Canada

[7] Womens Coll Hosp, Toronto, ON, Canada

[8] Canadian Partnership Canc, Toronto, ON, Canada

[9] Queens Univ, Dept Oncol, Kingston, ON, Canada

[10] Canadian Agcy Drugs & Technol Hlth, Toronto, ON, Canada

来源：

JNCI CANCER SPECTRUM | 2022年 / 6卷 / 04期

基金：

加拿大健康研究院;

关键词：

CARE; SURVIVAL; PRODIGE;

D O I：

10.1093/jncics/pkac047

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background There are no randomized control trials (RCTs) comparing gemcitabine and nab-paclitaxel (Gem-Nab) and fluorouracil, folinic acid, irinotecan, oxaliplatin (FOLFIRINOX) for advanced pancreatic cancer (APC). Although 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 vs FOLFIRINOX for APC. We aimed to examine the real-world cost-effectiveness of Gem-Nab vs FOLFIRINOX for APC in Ontario, Canada. Methods This study compared patients treated with first-line Gem-Nab or FOLFIRINOX for APC in Ontario from April 2015 to March 2019. 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 health-care payer's perspective. Sensitivity analysis was conducted using the propensity score matching method. Results A total of 1988 patients were identified (Gem-Nab: n = 928; FOLFIRINOX: n = 1060). Mean survival was lower for patients in the Gem-Nab than the FOLFIRINOX group (0.98 vs 1.26 life-years; incremental effectiveness = -0.28 life-years [95% confidence interval = -0.47 to -0.13]). 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 inpatient 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 and therefore not considered cost-effective at commonly accepted willingness-to-pay thresholds.

引用

页数：9

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