OBJECTIVES: Nab-paclitaxel Abraxane® plus gemcitabine (AG) and Fluorouracil, leucovorin, irinotecan, oxaliplatin (FOLFIRINOX) have shown significant clinical benefit and been widely used as 1^st-line treatment of metastatic pancreatic cancer (mPC) in China. This study aims to compare the cost-effectiveness of AG versus FOLFIRINOX regimen for the treatment of mPC patients in China.

METHODS: We developed a Markov model with a lifetime survival projection in Microsoft Excel® to simulate the progression of the mPC over time. Three health states in the model were defined: progression-free survival (PFS), progressed disease (PD) and death. The disease progression and death data from the real-world study results were used as clinical effectiveness input in the model. The drug costs were retrieved from IQVIA CHPA database. Other medical expenses including adverse events costs, laboratory test cost, hospitalization cost, and end-of-life cost were collected from public literatures and local clinician interviews. The quality-adjusted life years (QALYs), direct medical costs and incremental cost-effectiveness ratios (ICERs) were reported. We used life-time horizon and healthcare system perspective. Both QALY and costs were discounted at a rate of 3.5%. Uncertainty was assessed by one-way and probabilistic sensitivity analysis.

RESULTS: AG regimen provided an effectiveness of 1.35 QALY at an average cost of RMB 197,017 whereas FOLFIRINOX regimen brought 0.82 QALY at a cost of RMB 185,835 in a lifetime horizon. Therefore AG regimen was cost-effective with an ICER of RMB 21,375 compared with FOLFIRINOX regimen, far below the local threshold of 3 times GDP per capita in 2018 (RMB 193,932). AG arm generated less hospitalization cost and 2^nd-line treatment cost than FOLFIRINOX arm. Sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS: As the first study comparing cost-effectiveness of these two regimens, AG is likely the better option for the 1^st-line mPC treatment compared with FOLFIRINOX in China.