Presentation (CTI)

OBJECTIVES: Nab-paclitaxel plus gemcitabine (Gnp) is the standard of care for pancreatic cancer, but its medical costs are high. modified FOLFIRINOX (mFOLFIRINOX) and S-IROX have lower medical costs than Gnp, but their cost effectiveness is not always clear. This study aimed to evaluate the cost-effectiveness of mFOLFIRINOX and S-IROX from the payer's perspective in Japan.
METHODS: A partitioned survival analysis model was developed to predict cost and quality-adjusted life years (QALYs) for the GnP, mFOLFIRINOX, and S-IROX groups. Survival data were obtained from the phase III JCOG 1611 study. Drug costs were estimated based on Japanesedrug prices, and other cost parameters were estimated using the JMDC claims database; Lifetime horizon and a discount rate of 2% per year were applied. Utility weights were estimated based on previous studies. Incremental cost-effectiveness ratios (ICERs) formFOLFIRINOX and S-IROX compared to GnP were estimated. In addition, a sensitivity analysis (SA) was performed to assess heterogeneity, particularly anthropometric differences and parameter uncertainty.
RESULTS: The ICER of the mFOLFIRINOX group compared to the GnP group was estimated to be 12,407,549 yen/QALY, and that of the SI-ROX group was estimated to be 11,912,140 yen/QALY. The probability that the mFOLFIRINOX group was more cost effective than the GnP group was estimated to be 54.4 %. The probability that the S-IROX group would be cost effective compared to the GnP group was estimated to be 60.7%.
CONCLUSIONS: This study evaluated the cost-effectiveness of mFOLFIRINOX and S-IROX therapy for pancreatic cancer compared to the standard of care, GnP. As a result, Applying the willingness-to-pay threshold of 15 million yen/QALY, the results suggest that mFOLFIRINOX therapy and S-ROX are superior in cost effectiveness. However, the high incidence of adverse events suggests that further consideration is needed in the selection of treatment.