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Economic evaluation of NALIRIFOX vs. nab-paclitaxel and gemcitabine regimens for first-line treatment of metastatic pancreatic ductal adenocarcinoma from U.S. perspective.
- Source :
- Cost Effectiveness & Resource Allocation; 9/18/2024, Vol. 22 Issue 1, p1-11, 11p
- Publication Year :
- 2024
-
Abstract
- Background: The cost-effectiveness of NALIRIFOX as a potential new standard of care for patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) has yet to be established. Our objective was to evaluate the cost-effectiveness of NALIRIFOX vs. nab-paclitaxel and gemcitabine in this indication from the perspective of U.S. public payers. Methods: A partitioned survival model was constructed from the perspective of U.S. public payers, drawing on baseline patient characteristics and vital clinical data from the NAPOLI-3 trial. Costs and utilities were sourced from publicly accessible databases and literature. A lifetime horizon was applied, with an annual discount rate of 3%. We calculated and compared cumulative costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER). To evaluate the model's robustness, sensitivity analyses, scenario analyses, and subgroup analyses were carried out. Additionally, a price simulation for the costly liposomal irinotecan was conducted to inform the pricing strategy at the given willingness to pay (WTP) threshold. Results: In the base-case analysis, NALIRIFOX provided an additional 0.29 QALYs with an ICER of $206,340.69 /QALY compared to nab-paclitaxel and gemcitabine, indicating it is not cost-effective at a $150,000/QALY threshold. Sensitivity analysis showed the model was most sensitive to the costs of liposomal irinotecan, capecitabine, and post-progression care. Probabilistic sensitivity analysis indicated a 17.66% probability of NALIRIFOX being cost-effective at $150,000/QALY, rising to 47.48% at $200,000/QALY. Pricing simulations suggested NALIRIFOX could become cost-effective at $150,000/QALY if the price of irinotecan liposome drops to $53.24/mg (a 14.8% reduction). Conclusions: NALIRIFOX may not be cost-effective at its current price as a first-line treatment for patients with mPDAC in the long term. The cost of liposomal irinotecan has the greatest impact. It may become cost-effective only if its cost is reduced by 14.8%, with a WTP threshold of $150,000 /QALY. [ABSTRACT FROM AUTHOR]
- Subjects :
- THERAPEUTIC use of antineoplastic agents
IRINOTECAN
QUALITY-adjusted life years
COST effectiveness
ANTIMETABOLITES
DRUG side effects
RESEARCH funding
ANTINEOPLASTIC agents
PROBABILITY theory
PANCREATIC duct
DESCRIPTIVE statistics
PANCREATIC tumors
METASTASIS
GEMCITABINE
PACLITAXEL
CONFIDENCE intervals
MEDICAL care costs
Subjects
Details
- Language :
- English
- ISSN :
- 14787547
- Volume :
- 22
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Cost Effectiveness & Resource Allocation
- Publication Type :
- Academic Journal
- Accession number :
- 179710666
- Full Text :
- https://doi.org/10.1186/s12962-024-00578-5