OBJECTIVES: Pancreatic cancer is associated with poor prognosis and low median overall survival. Combination chemotherapy regimens, FOLFIRINOX and Gemcitabine/Nab-paclitaxel (GemNab), are the new adjuvant treatment standards for resectable pancreatic cancer. The PRODIGE and APACT trials demonstrated superior clinical outcomes with FOLFIRINOX and GemNab, each vs gemcitabine monotherapy, respectively. To inform decision makers about which of these treatments is optimal, we evaluated the cost-effectiveness of FOLFIRINOX vs GemNab for resected pancreatic cancer in adults from the U.S. payer perspective.

METHODS: A Markov model with three disease states (relapse free, progressive disease, and death) was developed. Cycle length was one month, and time horizon was 10 years. Transition probabilities were derived from PRODIGE and APACT survival data. All base case cost and utility values were obtained from published literature. Cost-effectiveness analysis was performed to obtain total costs, quality-adjusted life years (QALY), life years (LY) and incremental cost-effectiveness ratio (ICER). A 3% discount rate was applied to costs and outcomes. The effect of uncertainty on model parameters was assessed with one-way and probabilistic sensitivity analysis (PSA).

RESULTS: Our analysis estimated the cost for FOLFIRINOX was $40,831 higher than GemNab ($99,669 vs. $58,837). Despite increased toxicity, FOLFIRINOX was associated with additional 0.18 QALYs and 0.25 LYs compared to GemNab (QALY: 1.65 vs. 1.47; LY: 2.09 vs. 1.84). The ICER for FOLFIRINOX vs GemNab was $226,841/QALY and $163,325/LY. FOLFIRINOX was not cost-effective vs GemNab at a willingness-to-pay (WTP) threshold of $200,000/QALY and this was confirmed by PSA.

CONCLUSIONS: Total monthly cost for FOLFIRINOX was approximately 1.7 times higher than the cost for GemNab. If the WTP threshold increases to or above $250,000/QALY, FOLFIRINOX then becomes a cost-effective treatment option vs GemNab.