OBJECTIVES: Nab-paclitaxel Abraxane® plus gemcitabine (AG) and S-1 plus gemcitabine (GS) have shown significant clinical benefit and been widely used as 1^st-line treatment of metastatic pancreatic cancer (mPC) in China. This study aims to compare the cost-effectiveness of AG versus GS regimen for the treatment of mPC patients in China.

METHODS: We developed a Markov model with a lifetime survival projection in Microsoft Excel® to simulate the progression of the mPC over time. Three health states in the model were defined: progression-free survival (PFS), progressed disease (PD) and death. The hazard ratios (HRs) of disease progression and death from network meta-analysis results were used as clinical effectiveness inputs in the model. The drug costs were retrieved from IQVIA CHPA database. Other medical expenses including AE management costs, laboratory test cost, hospitalization cost, and end-of-life cost were collected from published literatures and/or local clinician interviews. The quality-adjusted life years (QALYs), direct medical costs and incremental cost-effectiveness ratios (ICERs) were reported. We used life-time horizon and healthcare system perspective. Both QALY and costs were discounted at a rate of 3.5%. Uncertainty was assessed by one-way and probabilistic sensitivity analysis.

RESULTS: AG regimen provided an effectiveness of 0.90 QALY at an average cost of RMB 164,925, whereas GS regimen brought 0.81 QALY at a cost of RMB 163,413 in a lifetime horizon. Therefore GS regimen was cost-effective with an ICER of RMB 16,507 compared with AG regimen, far below the local threshold of 3 times GDP per capita in 2018 (RMB 193,932). AG arm had less 2^nd-line treatment cost than GS arm. Sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS: As the first study comparing cost-effectiveness of these two regimens, AG is likely the better option for the 1^st-line mPC treatment compared with GS in China.