Economic evaluation of mm-398/5FU/LV for metastatic pancreatic cancer: An explorative cost-effectiveness analysis in a Norwegian setting

Abstract

Background: Over 700 people develop pancreatic cancer each year in Norway. Approximately 85% of them are diagnosed with metastatic pancreatic cancer. Metastatic pancreatic cancer is the spread of cancer from the pancreas to other organs. The first-line treatment options for these patients are best supportive care and palliative chemotherapy. For second-line treatment, the options are very limited for those who experience progression after chemotherapy, there are currently no other options than best supportive care. A combination therapy of nanoliposomal irinotecan (mm-398), fluorouracil (5-FU) and folinic acid (LV) poses a potential treatment option for the patients that experience progression after receiving gemcitabine based chemotherapy. Another potential treatment is a combination of 5FU and LV. Aim: This study is designed to compare the cost-effectiveness of mm-398/5-FU/LV and 5-FU/LV as second-line treatment for metastatic pancreatic patients who experienced progression after being treated with gemcitabine based chemotherapy. Methods: A Markov model was developed with life years gained (LYG) and costs per LYG as the outcomes. Costs were considered from a health care perspective. The model was both deterministic and probabilistic. A probabilistic sensitivity analysis (PSA) was conducted. The expected value of perfect information (EVPI) was calculated. Results: The incremental cost of mm-398/5-FU/LV is NOK 998 627; the incremental effect is 2.28 life years gained (LYG). Which gives us an incremental costeffectiveness ratio (ICER) of NOK 437 247. Conclusion: MM-398/5-FU/LV is the cost-effective choice if the WTP is NOK 437247 or higher. At a WTP below NOK 437 247, 5-FU/LV is the cost-effective choice. However, more knowledge is needed to minimize the uncertainty in the results.