Cargando…

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

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-w...

Descripción completa

Detalles Bibliográficos
Autores principales: Arciero, Vanessa, Luo, Jin, Parmar, Ambica, Dai, Wei Fang, Beca, Jaclyn M, Raphael, Michael J, Isaranuwatchai, Wanrudee, Habbous, Steven, Tadrous, Mina, Earle, Craig C, Biagi, Jim J, Mittmann, Nicole, Arias, Jessica, Gavura, Scott, Chan, Kelvin K W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9346632/
https://www.ncbi.nlm.nih.gov/pubmed/35758620
http://dx.doi.org/10.1093/jncics/pkac047
_version_ 1784761687089348608
author Arciero, Vanessa
Luo, Jin
Parmar, Ambica
Dai, Wei Fang
Beca, Jaclyn M
Raphael, Michael J
Isaranuwatchai, Wanrudee
Habbous, Steven
Tadrous, Mina
Earle, Craig C
Biagi, Jim J
Mittmann, Nicole
Arias, Jessica
Gavura, Scott
Chan, Kelvin K W
author_facet Arciero, Vanessa
Luo, Jin
Parmar, Ambica
Dai, Wei Fang
Beca, Jaclyn M
Raphael, Michael J
Isaranuwatchai, Wanrudee
Habbous, Steven
Tadrous, Mina
Earle, Craig C
Biagi, Jim J
Mittmann, Nicole
Arias, Jessica
Gavura, Scott
Chan, Kelvin K W
author_sort Arciero, Vanessa
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9346632
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-93466322022-08-04 Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer Arciero, Vanessa Luo, Jin Parmar, Ambica Dai, Wei Fang Beca, Jaclyn M Raphael, Michael J Isaranuwatchai, Wanrudee Habbous, Steven Tadrous, Mina Earle, Craig C Biagi, Jim J Mittmann, Nicole Arias, Jessica Gavura, Scott Chan, Kelvin K W JNCI Cancer Spectr Article 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. Oxford University Press 2022-06-27 /pmc/articles/PMC9346632/ /pubmed/35758620 http://dx.doi.org/10.1093/jncics/pkac047 Text en © The Author(s) 2022. Published by Oxford University Press. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Article
Arciero, Vanessa
Luo, Jin
Parmar, Ambica
Dai, Wei Fang
Beca, Jaclyn M
Raphael, Michael J
Isaranuwatchai, Wanrudee
Habbous, Steven
Tadrous, Mina
Earle, Craig C
Biagi, Jim J
Mittmann, Nicole
Arias, Jessica
Gavura, Scott
Chan, Kelvin K W
Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer
title Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer
title_full Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer
title_fullStr Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer
title_full_unstemmed Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer
title_short Real-World Cost-Effectiveness of First-Line Gemcitabine Plus Nab-Paclitaxel vs FOLFIRINOX in Patients With Advanced Pancreatic Cancer
title_sort real-world cost-effectiveness of first-line gemcitabine plus nab-paclitaxel vs folfirinox in patients with advanced pancreatic cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9346632/
https://www.ncbi.nlm.nih.gov/pubmed/35758620
http://dx.doi.org/10.1093/jncics/pkac047
work_keys_str_mv AT arcierovanessa realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT luojin realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT parmarambica realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT daiweifang realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT becajaclynm realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT raphaelmichaelj realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT isaranuwatchaiwanrudee realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT habboussteven realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT tadrousmina realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT earlecraigc realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT biagijimj realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT mittmannnicole realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT ariasjessica realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT gavurascott realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer
AT chankelvinkw realworldcosteffectivenessoffirstlinegemcitabineplusnabpaclitaxelvsfolfirinoxinpatientswithadvancedpancreaticcancer