OBJECTIVES: Pancreatic exocrine insufficiency (PEI) is common among patients with pancreatic cancer who have undergone pancreatic surgery. Patients suffering from PEI are unable to sufficiently maintain normal digestive processes leading to malnutrition and a reduced quality of life. Pancreatic enzyme replacement therapy (PERT) is used to manage PEI; however, the cost utility of PERT remains unclear. The aim of this study is to examine the cost-utility of PERT for treating PEI in patients who have undergone surgery due to pancreatic cancer in China.

METHODS: A 3-stage Markov model (uncontrolled PEI, controlled PEI and death, was developed to simulate the progress of patients suffering from PEI using monthly cycles over a five-year time horizon. Input data with respect to costs, effectiveness of PERT, overall survival and health-related quality of life were obtained from the literature, publicly available sources and through expert advice. The analysis was performed from a Chinese societal perspective with a willingness to pay threshold of 3xChinese GDP/capita (≈USD31,500). One-way sensitivity analyses and probabilistic sensitivity analyses (PSA) were performed.

RESULTS: The model estimated an average of 4.41 life years (LY) and 3.22 quality-adjusted life years (QALY) at a discounted cost of USD15,677 for patients treated with PERT. Patients who were untreated were predicted to live 3.12 LYs and 1.64 QALYs at a discounted cost of USD1,743. This resulted in an incremental cost-effectiveness ratio (ICER) of USD10,763/LY and USD8,813/QALY. The one-way sensitivity analyses showed that the main drivers of the model were cost of PERT (ICER range: USD10,712-USD6,913) and overall survival (ICER range: USD10,150-USD7,843). The PSA showed that >95% of the simulations fell below the threshold.

CONCLUSIONS: This study demonstrates that PERT is a cost-effective treatment for PEI in patients that have undergone surgery due to pancreatic cancer in China with an ICER estimated to be USD8,813/QALY.