Comparative effectiveness of FOLFIRINOX (FOL) versus gemcitabine and nab-paclitaxel (GNP) for the first-line treatment of metastatic pancreatic cancer.

Abstract

306 Background: ACCORD-11 and IMPaCT established the efficacy of combination chemotherapy with FOL and GNP in metastatic pancreatic cancer (mPC). These two regimens have different administration schedule and toxicity profile. In this study we compare the effectiveness and costs of the two regimens including the costs of toxicities and supportive medications from a societal perspective. Methods: A Markov model was developed to simulate a cohort of mPC patients to estimate the cost per life-year gained (LYG) and per quality-adjusted life-year (QALY) for treatment with FOL and GNP. The model has three states: stable disease, progressive disease, and death. The cohorts were modeled over a 3-year time horizon in a one-month cycle length. Efficacy data were obtained from respective trials. Drug acquisition costs were extracted from Veteran Affairs Federal Supply Schedules. Other costs including visits, tests, and procedures were derived from the Medicare physician-fee-schedule. Literature was reviewed to estimate the adverse event costs and the utility scores for each health state. One-way sensitivity analyses were performed to determine the robustness of the model to changes in key parameters. Results: The model projected a life expectancy of 9 months and 7 months for FOL and GNP, respectively. FOL group showed a higher QALY than GNP group (0.51 vs. 0.40). Although the drug acquisition costs were significantly lower in FOL compared with GNP, FOL yielded a slightly higher cost after 3-years period ($55,944 vs. $56,628). FOL treatment incurred an incremental cost of $1,334 per additional life-month ($16,012 per life-year) and an incremental cost of $30,870 per QALY gained. The median overall survival and progression-free survival point estimate greatly influenced model results based on the results of sensitivity analysis. Conclusions: Compared with GNP, FOL showed a slightly higher cost but higher life expectancy and QALY as a first-line treatment in mPC. Given that the toxicity profile account for a significant portion of cost for FOL providing best supportive care and management of side effects can significantly impact the overall costs of treatment.