Estimating the Cost-Effectiveness of Tumor-Treating Fields With Gemcitabine and Nabpaclitaxel for Frontline Treatment of Locally Advanced Pancreatic Adenocarcinoma
Author(s)
Greg Guzauskas, MSPH, PhD1, Jorge F. Nino de Rivera Guzman, MSc2, Bruce Wang, PhD3.
1The CHOICE Institute, Orcas, WA, USA, 2Health Economy specialist, Novocure, Glendale, CO, USA, 3Elysia Group, LLC, New York, NY, USA.
1The CHOICE Institute, Orcas, WA, USA, 2Health Economy specialist, Novocure, Glendale, CO, USA, 3Elysia Group, LLC, New York, NY, USA.
OBJECTIVES: To evaluate the cost-effectiveness of Tumor Treating Fields (TTFields) with standard of care (SOC; gemcitabine and nab-paclitaxel) versus SOC alone for first-line treatment of locally advanced pancreatic adenocarcinoma from a US payer perspective.
METHODS: Based on PANOVA-3, a randomized, open-label, pivotal phase III trial, a partitioned survival model was developed with three health states: distal progression-free, distal progression, and death. Parametric curves fit to trial Kaplan-Meier data were selected based on best statistical fit. Overall survival (OS) beyond year 3 was estimated using conditional survival probabilities from SEER data on pancreatic cancer (2000-2021). Trial data provided efficacy inputs, including pain-free survival (hazard ratio [HR] 0.74; 95% CI: 0.56-0.97; p=0.027). The US CMS DEMPOS fee schedule was used to estimate treatment costs, while supportive care costs and health state utilities were drawn from the literature. Pain-free survival data were used to estimate the disutility associated with pain for each treatment arm. Costs and outcomes were projected over a lifetime horizon, with a 3% annual discount rate applied to both
RESULTS: In the model, TTFields plus SOC yielded 2.27 life years and 1.66 quality-adjusted life years (QALYs), compared to 1.81 life years and 1.24 QALYs for SOC alone. Total costs were $443,942 with TTFields plus SOC and $287,738 with SOC alone, resulting in an incremental cost of $156,204. The incremental cost-effectiveness ratio was $373,367 per QALY gained.
CONCLUSIONS: TTFields therapy is the only novel treatment to show efficacy in the front-line setting for locally advanced pancreatic cancer. This analysis suggests TTFields may improve both survival and quality-adjusted life expectancy with reduced pain for patients. These results can inform value-based decision-making in a high-mortality cancer with limited therapeutic options.
METHODS: Based on PANOVA-3, a randomized, open-label, pivotal phase III trial, a partitioned survival model was developed with three health states: distal progression-free, distal progression, and death. Parametric curves fit to trial Kaplan-Meier data were selected based on best statistical fit. Overall survival (OS) beyond year 3 was estimated using conditional survival probabilities from SEER data on pancreatic cancer (2000-2021). Trial data provided efficacy inputs, including pain-free survival (hazard ratio [HR] 0.74; 95% CI: 0.56-0.97; p=0.027). The US CMS DEMPOS fee schedule was used to estimate treatment costs, while supportive care costs and health state utilities were drawn from the literature. Pain-free survival data were used to estimate the disutility associated with pain for each treatment arm. Costs and outcomes were projected over a lifetime horizon, with a 3% annual discount rate applied to both
RESULTS: In the model, TTFields plus SOC yielded 2.27 life years and 1.66 quality-adjusted life years (QALYs), compared to 1.81 life years and 1.24 QALYs for SOC alone. Total costs were $443,942 with TTFields plus SOC and $287,738 with SOC alone, resulting in an incremental cost of $156,204. The incremental cost-effectiveness ratio was $373,367 per QALY gained.
CONCLUSIONS: TTFields therapy is the only novel treatment to show efficacy in the front-line setting for locally advanced pancreatic cancer. This analysis suggests TTFields may improve both survival and quality-adjusted life expectancy with reduced pain for patients. These results can inform value-based decision-making in a high-mortality cancer with limited therapeutic options.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE425
Topic
Economic Evaluation
Disease
Oncology