Skip to main content
SpringerLink
Log in

Economic Evaluation for the UK of Systemic Chemotherapies as First-Line Treatment of Metastatic Pancreatic Cancer

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Background

Gemcitabine (GEM), oxaliplatin plus GEM (OX + GEM), cisplatin plus GEM (CIS + GEM), capecitabine plus GEM (CAP + GEM), FOLFIRINOX (FFX), and nab-paclitaxel plus GEM (NAB-P + GEM) are the most commonly used regimens as first-line treatment of metastatic pancreatic cancer (MPC) in the UK. Independent economic evaluation of these regimens simultaneously has not been conducted for the UK.

Objective

Using data from a network meta-analysis as efficacy measures, we estimated the cost effectiveness and cost utility of these regimens for the UK.

Methods

A three-state Markov model (progression-free, progressed-disease, and death) simulating the total costs and health outcomes (quality-adjusted life-years [QALYs] gained and life-years [LYs]) was developed to estimate the incremental cost-utility (ICUR) and incremental cost-effectiveness ratios (ICER) for patients with MPC, from the payer perspective. The model was specified to calculate total costs in 2017 British pounds (GBP, £). All values were discounted at 3.5% per year over a full lifetime horizon. One-way sensitivity and probabilistic sensitivity analyses were conducted to assess the impact of parameter uncertainty on the results.

Results

FFX was the most effective regimen, NAB-P + GEM was the most costly regimen, and GEM was the least costly and least effective regimen. OX + GEM, CIS + GEM, and NAB-P + GEM were dominated by CAP + GEM and FFX. Compared with GEM, the ICUR for CAP + GEM and FFX was £28,066 and £33,020/QALY gained, respectively; compared with GEM, the ICER for CAP + GEM and FFX was £17,437 and £22,291/LY gained, respectively; and compared with CAP + GEM, the ICUR and ICER for FFX were £34,947/QALY gained and 24,414/LY gained, respectively.

Conclusions

At a threshold value of £30,000/QALY, CAP + GEM was found to be the only cost-effective regimen in the management of MPC in the UK.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cancer Research UK. Pancreatic cancer statistics. 2013. http://www.cancerresearchuk.org/health-professional/pancreatic-cancer-statistics. Accessed 4 Sept 2017.

  2. Goel G, Sun W. Novel approaches in the management of pancreatic ductal adenocarcinoma: potential promises for the future. J Hematol Oncol. 2015;8:44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403–13.

    Article  CAS  PubMed  Google Scholar 

  4. Choi M, Razzaque S, Kim R. Systemic therapy of advanced pancreatic cancer: has the landscape changed? Clin Adv Hematol Oncol. 2012;10:442–51.

    PubMed  Google Scholar 

  5. Hu J, Zhao G, Wang H-X. A meta-analysis of gemcitabine containing chemotherapy for locally advanced and metastatic pancreatic adenocarcinoma. J Hematol Oncol. 2011;4:11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. National Cancer Institute of Canada Clinical Trials Group. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–6.

    Article  CAS  PubMed  Google Scholar 

  7. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. Groupe Tumeurs Digestives of Unicancer; PRODIGE Intergroup. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.

    Article  CAS  Google Scholar 

  8. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.

    Article  CAS  Google Scholar 

  9. Gharaibeh M, Bootman JL, McBride A, Martin J, Abraham I. Economic evaluations of first-line chemotherapy regimens for pancreatic cancer: a critical review. PharmacoEconomics. 2017;35:83–95.

    Article  PubMed  Google Scholar 

  10. National Institute for Health and Care Excellence. Paclitaxel as albumin-bound nanoparticles in combination with gemcitabine for previously untreated metastatic pancreatic cancer. 2015. https://www.nice.org.uk/Guidance/GID-TAG453/Documents. Accessed 4 Sept 2017.

  11. Gharaibeh M, McBride A, Bootman JL, Abraham I. Economic evaluation for the UK of nab-paclitaxel plus gemcitabine in the treatment of metastatic pancreas cancer. Br J Cancer. 2015;112:1301–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gresham GK, Wells GA, Gill S, Cameron C, Jonker DJ. Chemotherapy regimens for advanced pancreatic cancer: a systematic review and network meta-analysis. BMC Cancer. 2014;14:471.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Smyth EN, Bapat B, Ball DE, André T, Kaye JA. Metastatic pancreatic adenocarcinoma treatment patterns, health care resource use, and outcomes in France and the United Kingdom between 2009 and 2012: a retrospective study. Clin Ther. 2015;37:1301–16.

    Article  PubMed  Google Scholar 

  14. Colucci G, Labianca R, Di Costanzo F, Gebbia V, Cartenì G, Massidda B, et al. Gruppo Oncologico Italia Meridionale (GOIM); Gruppo Italiano per lo Studio dei Carcinomi dell’ Apparato Digerente (GISCAD); Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). Randomized phase III trial of gemcitabine plus cisplatin compared with single-agent gemcitabine as first-line treatment of patients with advanced pancreatic cancer: the GIP-1 study. J Clin Oncol. 2010;28:1645–51.

    Article  CAS  PubMed  Google Scholar 

  15. Cunningham D, Chau I, Stocken DD, Valle JW, Smith D, Steward W, et al. Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol. 2009;27:5513–8.

    Article  CAS  PubMed  Google Scholar 

  16. Herrmann R, Bodoky G, Ruhstaller T, Glimelius B, Bajetta E, Schüller J, Swiss Group for Clinical Cancer Research; Central European Cooperative Oncology Group, et al. Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol. 2007;25:2212–7.

    Article  CAS  PubMed  Google Scholar 

  17. Heinemann V, Quietzsch D, Gieseler F, Gonnermann M, Schönekäs H, Rost A, et al. Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol. 2006;24:3946–52.

    Article  CAS  PubMed  Google Scholar 

  18. Louvet C, Quietzsch D, Gieseler F, Gonnermann M, Schönekäs H, Rost A, et al. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol. 2005;23:3509–16.

    Article  CAS  PubMed  Google Scholar 

  19. Poplin E, Feng Y, Berlin J, Rothenberg ML, Hochster H, Mitchell E, et al. Phase III randomized study of gemcitabine and oxaliplatin versus gemcitabine (fixed-dose rate infusion) compared with gemcitabine (30-minute infusion) in patients with pancreatic carcinoma E6201: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27:3778–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Faluyi OO, Connor JL, Chatterjee M, Ikin C, Wong H, Palmer DH. Advanced pancreatic adenocarcinoma outcomes with transition from devolved to centralized care in a regional Cancer Centre. Br J Cancer. 2017;116:424–31.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Latimer N. NICE DSU Technical Support Document 14: Undertaking survival analysis for economic evaluations alongside clinical trials—extrapolation with patient-level data; 2011. http://nicedsu.org.uk/wp-content/uploads/2016/03/NICE-DSU-TSD-Survival-analysis.updated-March-2013.v2.pdf. Accessed 4 Sept 2017.

  22. Vemer P, Ramos IC, van Voorn GAK, Al MJ, Feenstra TL. AdViSHE. A validation-assessment tool of health-economic models for decision makers and model users. Pharmacoeconomics. 2016;34:349–61.

    Article  CAS  PubMed  Google Scholar 

  23. Gharaibeh M, Patel H, McBride A, Bootman JL, Abraham I. Weibull and exponential proportional hazard modelling for optimizing economic evaluations of cancer treatments: FOLFIRINOX (FFX) vs gemcitabine (GEM) in metastatic pancreas cancer (mPC) [abstract no. e15704]. J Clin Oncol. 2016;34(Suppl_15):e15704.

    Article  Google Scholar 

  24. Sacco JJ, Botten J, Macbeth F, Bagust A, Clark P. The average body surface area of adult cancer patients in the UK: a multicentre retrospective study. PLoS One. 2010;5:e8933.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. The British National Formulary. 2014. https://www.evidence.nhs.uk/formulary/bnf/current. Accessed 21 Apr 2018.

  26. Department of Health. NHS reference costs 2012–2013. 2015. https://www.gov.uk/government/publications/nhs-reference-costs-2014-to-2015. Accessed 21 Apr 2018.

  27. Personal Social Services Research Unit. Unit Costs of Health and Social Care 2015 PSSRU. 2015. http://www.pssru.ac.uk/project-pages/unit-costs/2015/. Accessed 21 Apr 2018.

  28. United Kingdom Consumer Price Index. United Kingdom Inflation Rate. 2016. http://www.rateinflation.com/inflation-rate/uk-inflation-rate.php. Accessed 4 Sept 2017.

  29. Lloyd A, Nafees B, Narewska J, Dewilde S, Watkins J. Health state utilities for metastatic breast cancer. Br J Cancer. 2006;95:683–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J. Health state utilities for non small cell lung cancer. Health Qual Life Outcomes. 2008;6:84.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Swinburn P, Lloyd A, Nathan P, Choueiri TK, Cella D, Neary MP. Elicitation of health state utilities in metastatic renal cell carcinoma. Curr Med Res Opin. 2010;26:1091–6.

    Article  PubMed  Google Scholar 

  32. Tolley K, Goad C, Yi Y, Maroudas P, Haiderali A, Thompson G. Utility elicitation study in the UK general public for late-stage chronic lymphocytic leukaemia. Eur J Health Econ. 2013;14:749–59.

    Article  PubMed  Google Scholar 

  33. Tam VC, Ko YJ, Mittmann N, Cheung MC, Kumar K, Hassan S, et al. Cost-effectiveness of systemic therapies for metastatic pancreatic cancer. Curr Oncol. 2013;20:e90–106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Romanus D, Kindler HL, Archer L, Basch E, Niedzwiecki D, Weeks J, Cancer and Leukemia Group B, et al. Does health-related quality of life improve for advanced pancreatic cancer patients who respond to gemcitabine? Analysis of a randomized phase III trial of the cancer and leukemia group B (CALGB 80303). J Pain Symptom Manage. 2012;43:205–17.

    Article  CAS  PubMed  Google Scholar 

  35. Coyle D, Ko YJ, Coyle K, Saluja R, Shah K, Lien K, et al. Cost-effectiveness analysis of systemic therapies in advanced pancreatic cancer in the Canadian health care system. Value Health. 2017;20:586–92.

    Article  PubMed  Google Scholar 

  36. Stainthorpe A, Greenhalgh J, Bagust A, Richardson M, Boland A, Beale S, et al. Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer: an evidence review group perspective of a NICE Single Technology Appraisal. Pharmacoeconomics. 2018. https://doi.org/10.1007/s40273-018-0646-1 (Epub 29 Mar 2018).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Malin JL. Wrestling with the high price of cancer care: should we control costs by individuals’ ability to pay or society’s willingness to pay? J Clin Oncol. 2010;28:3212–4.

    Article  PubMed  Google Scholar 

  38. Mason A, Drummond M, Ramsey S, Campbell J, Raisch D. Comparison of anticancer drug coverage decisions in the United States and United Kingdom: does the evidence support the rhetoric? J Clin Oncol. 2010;28:3234–8.

    Article  PubMed  Google Scholar 

  39. Pancreatic Cancer Action. FOLFIRINOX. 2016. https://pancreaticcanceraction.org/about-pancreatic-cancer/treatment/chemotherapy/chemotherapy-drugs-for-pancreatic-cancer/folfirinox/. Accessed 4 Sept 2017.

  40. Drummond M, Towse A. Is it time to reconsider the role of patient co-payments for pharmaceuticals in Europe? Eur J Health Econ. 2012;13:1–5.

    Article  PubMed  Google Scholar 

  41. Weinfurt KP. Value of high-cost cancer care: a behavioral science perspective. J Clin Oncol. 2007;25:223–7.

    Article  PubMed  Google Scholar 

  42. Lang HC. Willingness to pay for lung cancer treatment. Value Health. 2010;13:743–9.

    Article  PubMed  Google Scholar 

  43. Wong YN, Hamilton O, Egleston B, Salador K, Murphy C, Meropol NJ. Understanding how out-of-pocket expenses, treatment value, and patient characteristics influence treatment choices. Oncologist. 2010;15:566–76.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lakdawalla DN, Romley JA, Sanchez Y, Maclean JR, Penrod JR, Philipson T. How cancer patients value hope and the implications for cost-effectiveness assessments of high-cost cancer therapies. Health Aff (Millwood). 2012;31:676–82.

    Article  PubMed  Google Scholar 

  45. Gaskin DJ, Kong J, Meropol NJ, Yabroff KR, Weaver C, Schulman KA. Treatment choices by seriously ill patients: the Health Stock Risk Adjustment Model. Med Decis Mak. 1998;18:84–94.

    Article  CAS  Google Scholar 

  46. Oettle H. Progress in the knowledge and treatment of advanced pancreatic cancer: from benchside to bedside. Cancer Treat Rev. 2014;40:1039–47.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Stephanie Fletcher for her assistance in the technical preparation of this manuscript.

Author information

Authors and Affiliations

  1. Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA

    Mahdi Gharaibeh, Brian Erstad, Marion Slack, Nimer Alsaid, J. Lyle Bootman & Ivo Abraham

  2. University of Arizona Cancer Center, Tucson, AZ, USA

    Ali McBride, David S. Alberts & Ivo Abraham

  3. Banner University Medical Center-Tucson, Tucson, AZ, USA

    Ali McBride

  4. Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Drachman Hall B-306, 1295 N. Martin Ave, Tucson, AZ, 85721, USA

    Ali McBride, Brian Erstad, Marion Slack, Nimer Alsaid, J. Lyle Bootman & Ivo Abraham

  5. Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ, USA

    Ivo Abraham

Authors
  1. Mahdi Gharaibeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ali McBride
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David S. Alberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian Erstad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marion Slack
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nimer Alsaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Lyle Bootman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ivo Abraham
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and overall approach: MG, AM, JLB, NA, IA. Study design: MG, IA. Interpretation of results: MG, AM, DA, MS, BE, JLB, IA. Clinical guidance: AM, DA. Drafting of the manuscript: MG, IA. Critical review of manuscript: AM, DA, BE, MS, JLB.

Corresponding author

Correspondence to Ivo Abraham.

Ethics declarations

Conflict of interest

Mahdi Gharaibeh. Ali McBride, David S. Alberts, Marion Slack, Brian Erstad, J. Lyle Bootman, Nimer Alsaid, and Ivo Abraham declare no competing interests.

Research Support

This analysis was conducted independently and without external funding support.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 150 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gharaibeh, M., McBride, A., Alberts, D.S. et al. Economic Evaluation for the UK of Systemic Chemotherapies as First-Line Treatment of Metastatic Pancreatic Cancer. PharmacoEconomics 36, 1333–1343 (2018). https://doi.org/10.1007/s40273-018-0684-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-018-0684-8

Search

Navigation