Cost-effectiveness of first-line treatments for metastatic pancreatic cancer.

Authors

Ying Dong, Yiqing Yin, Guiyue Wang, Gengwei Huo

Published in

Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. Jul 10, 2026. Epub Jul 10, 2026.

Abstract

The NAPOLI-3 trial demonstrated that NALIRIFOX significantly improves overall survival (OS) and progression-free survival (PFS) compared with nab-paclitaxel plus gemcitabine (GEM-NAB-PAC), while the PRODIGE4-ACCORD11 trial showed a survival benefit of FOLFIRINOX over gemcitabine in patients with metastatic pancreatic cancer. Notably, these trials enrolled previously untreated patients, establishing NALIRIFOX, GEM-NAB-PAC, and FOLFIRINOX as first-line treatment options. Given the high costs and toxicity associated with these regimens, an economic evaluation is needed to inform treatment selection. Therefore, this study evaluated the cost-effectiveness of first-line NALIRIFOX, GEM-NAB-PAC, and FOLFIRINOX compared with gemcitabine in patients with metastatic pancreatic adenocarcinoma from a U.S. healthcare payer perspective.
A three-state partitioned survival model was developed with a lifetime horizon and a 1-week cycle length. Clinical efficacy data were derived from the NAPOLI-3 and PRODIGE4-ACCORD11 trials. Costs, health state utilities, and adverse event disutilities were obtained from published literature and public databases. Costs and outcomes were discounted at an annual rate of 3%. Total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. A willingness-to-pay (WTP) threshold of US$150,000 per QALY was applied. Deterministic and probabilistic sensitivity analyses were conducted to assess model robustness.
Model-predicted median PFS and OS closely matched trial-reported outcomes, supporting good internal validity. In the base-case analysis, using gemcitabine as the reference comparator, FOLFIRINOX demonstrated the most favorable cost-effectiveness, with an ICER of US$6,864 per QALY gained. NALIRIFOX yielded the largest QALY gain and had an ICER of US$114,614 per QALY, whereas GEM-NAB-PAC was associated with the highest ICER (US$231,750 per QALY). At the WTP threshold of US$150,000 per QALY, FOLFIRINOX and NALIRIFOX were considered cost-effective compared with gemcitabine, while GEM-NAB-PAC was not.
From a U.S. healthcare payer perspective, FOLFIRINOX represents the most cost-effective first-line treatment for metastatic pancreatic cancer, while NALIRIFOX may be considered a cost-effective alternative at commonly accepted WTP thresholds. GEM-NAB-PAC was not cost-effective under the base-case assumptions.

PMID:
42430100
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.