Cost-Effectiveness of NALIRIFOX As a First-Line Treatment for Metastatic Pancreatic Cancer in Taiwan
Author(s)
MING-YU HONG, Bachelor’s degree1, Chen-Han Chueh, PhD1, Wei-ming Huang, PharmD, MD1, Nai-Jung Chiang, PhD2, Yi-Wen Tsai, PhD1;
1National Yang Ming Chiao Tung University, Institute of Health and Welfare Policy, Taipei, Taiwan, 2Taipei Veterans General Hospital, Taipei, Taiwan
1National Yang Ming Chiao Tung University, Institute of Health and Welfare Policy, Taipei, Taiwan, 2Taipei Veterans General Hospital, Taipei, Taiwan
Presentation Documents
OBJECTIVES: The NAPOLI 3 trial demonstrated that NALIRIFOX, a novel combined systemic chemotherapy regimen, significantly improves survival compared to gemcitabine plus nab-paclitaxel (GEM/NAB-P) in patients with metastatic pancreatic cancer (mPC). Despite its clinical benefits, previous economic evaluations from the US and China perspectives concluded that the NALIRIFOX is not cost-effective. This study aims to evaluate the cost-effectiveness of NALIRIFOX as a first-line systemic treatment for patients with mPC compared to GEM/NAB-P, from the perspective of Taiwan's National Health Insurance Administration (NHIA).
METHODS: A three-state partitioned survival model, comprising progression-free (PF), progressed disease (PD), and death states, was developed to evaluate the cost-effectiveness over 40 years. Efficacy was sourced from the NAPOLI 3 trial. Direct medical costs, including medication, non-medication, and subsequent costs during the PD state, were estimated from Taiwan NHI claims data. Other parameters were retrieved from published literature. Cost-effectiveness was assessed on the estimated incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB), using a willingness-to-pay threshold set at three times the gross domestic product (GDP) per capita in 2023 (NT$3,023,055). Quality-adjusted life-years (QALYs) and costs were discounted at an annual rate of 3%. Uncertainty was explored through deterministic and probabilistic sensitivity analyses (PSA).
RESULTS: Compared with GEM/NAB-P, NALIRIFOX demonstrated an increase of 0.17 life-years and 0.11 QALYs, with an incremental cost of NT$239,594. This results in an ICER of NT$2,250,212 per QALY and an INMB of NT$82,289.5. The PSA indicated that NALIRIFOX has a 58.4% probability of being cost-effective, with an expected value of perfect information of NT$60,527. The deterministic sensitivity analysis revealed that the most influential parameters on uncertainty were the costs of NALIRIFOX, the utility value during the PF state, and the subsequent costs.
CONCLUSIONS: Unlike previous studies, our findings indicate that NALIRIFOX is cost-effective compared with GEM/NAB-P from the perspective of Taiwan's NHIA, despite considerable uncertainty.
METHODS: A three-state partitioned survival model, comprising progression-free (PF), progressed disease (PD), and death states, was developed to evaluate the cost-effectiveness over 40 years. Efficacy was sourced from the NAPOLI 3 trial. Direct medical costs, including medication, non-medication, and subsequent costs during the PD state, were estimated from Taiwan NHI claims data. Other parameters were retrieved from published literature. Cost-effectiveness was assessed on the estimated incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB), using a willingness-to-pay threshold set at three times the gross domestic product (GDP) per capita in 2023 (NT$3,023,055). Quality-adjusted life-years (QALYs) and costs were discounted at an annual rate of 3%. Uncertainty was explored through deterministic and probabilistic sensitivity analyses (PSA).
RESULTS: Compared with GEM/NAB-P, NALIRIFOX demonstrated an increase of 0.17 life-years and 0.11 QALYs, with an incremental cost of NT$239,594. This results in an ICER of NT$2,250,212 per QALY and an INMB of NT$82,289.5. The PSA indicated that NALIRIFOX has a 58.4% probability of being cost-effective, with an expected value of perfect information of NT$60,527. The deterministic sensitivity analysis revealed that the most influential parameters on uncertainty were the costs of NALIRIFOX, the utility value during the PF state, and the subsequent costs.
CONCLUSIONS: Unlike previous studies, our findings indicate that NALIRIFOX is cost-effective compared with GEM/NAB-P from the perspective of Taiwan's NHIA, despite considerable uncertainty.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE286
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology