COMPARATIVE COST-EFFECTIVENESS OF FIRST LINE THERAPY FOR METASTATIC OR RECURRENT PANCREATIC CANCER IN JAPAN
Author(s)
INOUE MAHO, MS1, Kosuke MORIMOTO, PhD2, Munenobu Kashiwa, PhD3, Kensuke Moriwaki, BS, MS, PhD4.
1Ritsumeikan University, Kusatsu-shi, Japan, 2Ritsumeikan University, Kyoto-shi, Japan, 3Ritsumeikan University, Kyoto, Japan, 4Associate Professor, Ritsumeikan University, Kyoto, Japan.
1Ritsumeikan University, Kusatsu-shi, Japan, 2Ritsumeikan University, Kyoto-shi, Japan, 3Ritsumeikan University, Kyoto, Japan, 4Associate Professor, Ritsumeikan University, Kyoto, Japan.
OBJECTIVES: Several regimens are used as first-line treatments for pancreatic cancer, including FOLFIRINOX, gemcitabine plus nab-paclitaxel (GnP), gemcitabine (GEM), S-1, S-1 plus GEM, and FOLFIRI plus GEM. In addition, recent clinical trials have demonstrated the efficacy of S-IROX and modified FOLFIRINOX (mFOLFIRINOX). However, these regimens are expensive, and their relative cost-effectiveness remains unclear. Therefore, this study aimed to evaluate the relative cost-effectiveness of first-line treatments for metastatic or recurrent pancreatic cancer in Japan from the perspective of the public healthcare payer.
METHODS: A partitioned survival analysis model was developed to estimate costs and quality-adjusted life years (QALYs) for each regimen. Survival data for GnP were obtained from the JCOG1611 trial. Hazard ratios (HR) on survival compared to GnP were estimated based on multiple clinical trials using a network meta-analysis (NMA), and survival outcomes for other regimens were derived by applying the estimated HR to the GnP survival data. Drug costs were based on drug price standards, and other cost parameters were estimated using the JMDC Claims Database the largest epidemiological receipt database in Japan. Utility weights were estimated based on previous foreign studies. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen. Sensitivity analyses were conducted to assess parameter uncertainty.
RESULTS: The base case analysis showed an ICER of 9,469,243 JPY/QALY for S-1+GEM compared to S-1. The ICER for S-IROX compared to S-1+GEM was 36,692,835 JPY/QALY. The ICER for mFOLFIRINOX compared to S-IROX was 47,128,090 JPY/QALY. The sensitivity analysis revealed that the parameter exhibiting the most significant variation was HR.
CONCLUSIONS: At a threshold of 7.5 million JPY/ QALY, S-1 demonstrated superior cost-effectiveness. At thresholds of 11.25 million JPY/QALY and 15 million JPY/QALY, S-1+GEM demonstrated superior cost-effectiveness. This study is expected to support decision-making in healthcare policy and clinical practice.
METHODS: A partitioned survival analysis model was developed to estimate costs and quality-adjusted life years (QALYs) for each regimen. Survival data for GnP were obtained from the JCOG1611 trial. Hazard ratios (HR) on survival compared to GnP were estimated based on multiple clinical trials using a network meta-analysis (NMA), and survival outcomes for other regimens were derived by applying the estimated HR to the GnP survival data. Drug costs were based on drug price standards, and other cost parameters were estimated using the JMDC Claims Database the largest epidemiological receipt database in Japan. Utility weights were estimated based on previous foreign studies. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen. Sensitivity analyses were conducted to assess parameter uncertainty.
RESULTS: The base case analysis showed an ICER of 9,469,243 JPY/QALY for S-1+GEM compared to S-1. The ICER for S-IROX compared to S-1+GEM was 36,692,835 JPY/QALY. The ICER for mFOLFIRINOX compared to S-IROX was 47,128,090 JPY/QALY. The sensitivity analysis revealed that the parameter exhibiting the most significant variation was HR.
CONCLUSIONS: At a threshold of 7.5 million JPY/ QALY, S-1 demonstrated superior cost-effectiveness. At thresholds of 11.25 million JPY/QALY and 15 million JPY/QALY, S-1+GEM demonstrated superior cost-effectiveness. This study is expected to support decision-making in healthcare policy and clinical practice.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE98
Topic
Economic Evaluation
Disease
SDC: Oncology