OBJECTIVES: Nab-paclitaxel is a solvent-free paclitaxel formulation approved for first-line treatment of patients with metastatic pancreatic cancer (MPC) in combination with gemcitabine. Treatment with nab-paclitaxel and gemcitabine has been shown to be clinically effective in an area of high unmet need. Patients treated with nab-paclitaxel and gemcitabine had an increase in median survival of 3.3 months compared to those treated with gemcitabine alone in patient subgroup with Karnofsky Performance Score 70-80. METHODS: A Markov cohort model was constructed for patients with MPC to examine the costs and outcomes of nab-paclitaxel and gemcitabine versus gemcitabine. Health outcomes were expressed in terms of life-years (LYs) and quality-adjusted life-years (QALYs) gained. Patient's disease progression over time was modeled using data from the MPACT study. An area under the curve methodology was used to characterize patients’ disease status at different points in time. Parametric curves were fitted to the overall survival data, progression-free survival data and time on treatment data. Health Related Quality of Life data for each health state was sourced systematically from the literature. Resource unit costs and use were derived from local cross-sectional survey. The analysis was performed from payer’s perspective in Slovak settings. RESULTS: The base case result was an incremental cost-effectiveness ratio (ICER) of € 27,769 per QALY gained for paclitaxel albumin plus gemcitabine versus gemcitabine, based on an incremental cost of € 5,943, incremental survival of 3.3 months and incremental QALYs of 0.214. The key driver of the incremental costs was the additional drug acquisition cost of adding nab-paclitaxel to gemcitabine. CONCLUSIONS: € 28 820 per QALY is defined as the upper limit for conditional reimbursement in Slovakia. Nab-paclitaxel and gemcitabine is the cost-effective option for the first-line treatment of patients with MPC as it delivers a survival advantage at a moderate price increase.