OBJECTIVES: Gemcitabine (GEM), oxaliplatin plus GEM (OX+GEM), cisplatin plus GEM (CIS+GEM), capecitabine plus GEM (CAP+GEM), FOLFIRINOX (FFX), and Nab-paclitaxel plus gemcitabine (NAB-P+GEM) are the most commonly used first-line treatment options for metastatic pancreatic cancer (MPC) in the UK. A comprehensive independent economic evaluation for these regimens has not been conducted for the UK. METHODS: A state transition model with full time horizon was used to estimate the life years (LY) and quality-adjusted life years (QALY) gained and incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) for all regimens. Direct and indirect efficacy estimates were obtained from published clinical trials. Health-states utility values were adjusted from a US sample to represent sample of the UK population. Adverse events utility decrements were obtained from published clinical trials using EQ-5D questionnaire from British population. A 3.5%/year discount rate was used and all costs were presented in 2016 GB£. RESULTS: NAB-P+GEM was dominated by FFX (NAB-P+GEM was more costly with incremental costs of £3,109, and less effective with incremental QALYs of –0.144). OX+GEM and CIS+GEM were dominated by CAP+GEM (OX+GEM was more costly with incremental costs of £3,109, and less effective with incremental QALYs of –0.144; and CIS+GEM was more costly with incremental costs of £1,947, and less effective with incremental QALYs of 0.07). The ICUR for CAP+GEM compared with GEM alone was £28,006 per QALY gained (incremental costs, £1,935; incremental QALYs, 0.07), and the ICER was £17,437 per LYG gained (incremental LYs, 0.11). The ICUR for FFX compared with GEM was £33,020 per QALY gained (incremental costs, £8,130; incremental QALYs, 0.247), and the ICER was £22,291 per LYG gained (incremental LYs, 0.365). CONCLUSIONS: The availability of less costly and more effective options such as FFX and CAP+GEM, make NAB-P+GEM, OX+GEM, and CIS+GEM less preferred regimens in the management of MPC in the UK.