Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
University of Arizona Cancer Center, Tucson, AZ, USA.
Pharmacoeconomics. 2018 Nov;36(11):1333-1343. doi: 10.1007/s40273-018-0684-8.
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.
Using data from a network meta-analysis as efficacy measures, we estimated the cost effectiveness and cost utility of these regimens for the UK.
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.
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.
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.
在英国，吉西他滨（GEM）、奥沙利铂联合吉西他滨（OX+GEM）、顺铂联合吉西他滨（CIS+GEM）、卡培他滨联合吉西他滨（CAP+GEM）、FOLFIRINOX（FFX）和白蛋白紫杉醇联合吉西他滨（NAB-P+GEM）是转移性胰腺癌（MPC）一线治疗中最常用的方案。目前尚未对英国这些方案进行独立的经济评估。
本研究使用网络荟萃分析数据作为疗效指标，估算了这些方案在英国的成本效果和成本效用。
采用三状态马尔可夫模型（无进展、疾病进展和死亡）模拟转移性胰腺癌患者的总费用和健康结果（质量调整生命年[QALYs]和生命年[LYs]），从支付者的角度估算 MPC 患者的增量成本效用（ICUR）和增量成本效果比（ICER）。该模型被指定为计算 2017 年英国英镑（GBP，£）的总费用。所有值均在整个生命周期内以每年 3.5%的贴现率贴现。进行了单因素敏感性分析和概率敏感性分析，以评估参数不确定性对结果的影响。
FFX 是最有效的方案，NAB-P+GEM 是最昂贵的方案，GEM 是最便宜和最无效的方案。OX+GEM、CIS+GEM 和 NAB-P+GEM 均被 CAP+GEM 和 FFX 所主导。与 GEM 相比，CAP+GEM 和 FFX 的 ICUR 分别为 £28066 和 £33020/QALY；与 GEM 相比，CAP+GEM 和 FFX 的 ICER 分别为 £17437 和 £22291/LY；与 CAP+GEM 相比，FFX 的 ICUR 和 ICER 分别为 £34947/QALY 和 £24414/LY。
在 £30000/QALY 的阈值下，CAP+GEM 被认为是英国 MPC 管理的唯一具有成本效果的方案。
