Cost-effectiveness of FOLFIRINOX for first-line treatment of metastatic pancreatic cancer

Background The accord 11/0402 trial demonstrated that FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, oxaliplatin) is significantly more efficacious than gemcitabine monotherapy in the first-line treatment of metastatic pancreatic cancer (MPC). The present study assessed the cost-effectiveness of first-line FOLFIRINOX compared with first-line gemcitabine for public payers in Canada. Methods A Markov model simulated the movement of MPC patients from first-line treatment until death. Overall survival (os) and progression-free survival (PFS) data were derived from accord. Published utility data and Canadian costs were applied based on time in each health state and on treatment-related adverse event (AE) rates. Costs included first-and second-line therapy, monitoring, and costs to treat AES. Two separate analyses were performed. Analysis 1 was based on trial data [first-line FOLFIRINOX followed by second-line gemcitabine compared with first-line gemcitabine followed by second-line platinum-based chemotherapy, with use of granulocyte colony-stimulating factor (G-CSF) allowed], and analysis 2 used Ontario treatment patterns before FOLFIRINOX funding (first-line FOLFIRINOX followed by second-line gemcitabine compared with first-line gemcitabine followed by best supportive care, no use of G-CSF). Results Compared with first-line gemcitabine, first-line FOLFIRINOX resulted in more life-years and quality adjusted life-years (QALYS). Probabilistic sensitivity analysis results showed that, for analyses 1 and 2 respectively, FOLFIRINOX has a greater than 85% probability and an approximately 80% probability of being cost-effective at the $100,000 threshold. Conclusions Compared with gemcitabine, first-line FOLFIRINOX significantly prolongs median os. Given the favourable cost per QALY, the improvement in clinical efficacy, and the limited available treatment options, FOLFIRINOX represents an attractive cost-effective treatment for MPC.