PCN248 COST-UTILITY ANALYSIS OF FIRST-LINE THERAPY FOR ADVANCED AND METASTATIC PANCREATIC CANCER IN JAPAN.

Abstract

A purpose of cancer treatment for advanced and metastatic pancreatic cancer (AMPC) is to improve survival and quality of life. In Japan, S-1 is one of treatment regimens applied as a first-line therapy and no economic evaluation including these regimens have not been conducted. We conducted cost-utility analysis based on a network meta-analysis of the first-line therapy for AMPC under Japanese clinical environment. A partitioned survival model, weekly-cycled with three health states was used to compare six regimens recommended by Japanese guideline for first-line therapy for AMPC (Ex : Gemcitabine, its combination with Nab-Paclitaxel or FOLFIRINOX, and S-1). Base proportions of patients in each health state were determined by the area under the curve based on the estimated overall survival and progress free survival of Gemcitabine in phase3 clinical trials. Effectiveness of comparative regimen were used relative hazard ratio (HR) that calculated by the network meta-analysis to Gemcitabine. Cost were calculated from resource use based on expert opinions in Japan or obtained from literature. And, health state utilities were sourced from EQ-5D-5L research in expert panel in Japan. The public health care payer perspective was considered. Costs and outcomes were discounted at 2%. Sensitivity analyses including probability sensitive analysis were performed. Compared to Gemcitabine, FOLFIRINOX was associated with a gain of 3,843,731 yen (6,053,833 vs 2,210,102) in cost and 0.516 (0.987 vs 0.471) in quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER) equal to 7,449,682 yen/QALY. ICER of the combination of Gemcitabine and Nab-Paclitaxel compare to Gemcitabine equal to 18,017,944 yen/QALY. PFS-HR and utility value of grade 3/4 SE were the most influential setting in the one-way sensitive analysis. The best cost-effective regimen for AMPC in Japan is FOLFIRINOX regimen. We are considering additional analysis taking into account transition to second-line therapy, terminal care cost, and clinical practice.