Objectives: To evaluate the cost-effectiveness of the liposomal Irinotecan (nal-IRI) plus 5-Fluorouracil (5-FU)/ Leucovorin (LV) compare to 5-FU/LV alone for the treatment of patients with metastatic pancreatic cancer (mPDAC) who have previously received gemcitabine-based regimens in Greece.
Methods: A partitioned survival model was locally adapted from a public payer perspective over a 10-year time horizon. Utility values, efficacy and safety data applied in the model, were extracted from the literature. Resource consumption data were obtained from local experts using a questionnaire, developed for the purposes of the study, and were combined with unit costs (in €2019) obtained from official sources. Primary outcomes were patients’ life years (LYs), quality-adjusted life years (QALYs), total-costs, and incremental cost-effectiveness ratio (ICER) per QALY and LY gained. Both costs and outcomes were discounted at 3.5% per annum. A one-way sensitivity analysis (OWSA) was undertaken to test the robustness of the results and a probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty in the model.
Results: The analysis revealed that, the total cost per patient was estimated to be €21,468 and €4,758 for nal-IRI+5-FU/LV and 5-FU/LV respectively. In terms of health outcomes, nal-IRI+5-FU/LV was associated with 0.58 QALYs and 0.85 LYs, while patients who received 5-FU/LV alone accrued 0.43 QALYs and 0.64 LYs. The incremental analysis showed that nal-IRI+5-FU/LV resulted in an ICER of €114,153 per QALY gained and €79,799 per LY gained versus 5-FU/LV alone. OWSA results indicated that the most influential parameter on the model was utility values assigned to the pre-progression state. PSA confirmed the deterministic results.
Conclusions: The present economic evaluation suggests that nal-IRI+5-FU/LV, a therapy that provides survival benefits to patients with mPDAC after disease progression following gemcitabine-based treatment, was estimated to be a good value for money treatment option for the Greek patients.