An Italian cost-effectiveness analysis of paclitaxel albumin (nab-paclitaxel) + gemcitabine vs gemcitabine alone for metastatic pancreatic cancer patients: the APICE study

Carlo Lazzaro, Carlo Barone, Francesco Caprioni, Stefano Cascinu, Alfredo Falcone, Evaristo Maiello, Michele Milella, Carmine Pinto, Michele Reni, Giampaolo Tortora

Research output: Contribution to journalArticle

Abstract

BACKGROUND: the APICE study evaluates the cost-effectiveness of nanoparticle albumin-bound paclitaxel (nab-paclitaxel - Nab-P) + gemcitabine (G) vs G alone in metastatic pancreatic cancer (MPC) from the Italian National Health Service (INHS) standpoint.

RESEARCH DESIGN AND METHODS: A 4-year, 4 health states (progression-free; progressed; end of life; death) Markov model based on the MPACT trial was developed to estimate costs (Euro [€], 2017 values), and quality-adjusted life years (QALYs). Patients were assumed to receive intravenously Nab-P 125 mg/m2 + G 1000 mg/m2 on days 1, 8, and 15 every 4 weeks or G alone 1000 mg/m2 weekly for 7 out of 8 weeks (cycle 1) and then on days 1, 8, and 15 every 4 weeks (cycle 2 and subsequent cycles) until progression. One-way and probabilistic sensitivity analyses explored the uncertainty surrounding the baseline incremental cost-utility ratio (ICUR).

RESULTS: Nab-P + G totals 0.154 incremental QALYs and €7082.68 incremental costs vs G alone. ICUR (€46,021.58) is lower than the informal threshold value of €87,330 adopted by the Italian Medicines Agency during 2010-2013 for reimbursing oncological drugs. Sensitivity analyses confirmed the robustness of the baseline findings.

CONCLUSIONS: Nab-P + G in MPC patients can be considered cost-effective for the INHS.

Original languageEnglish
Pages (from-to)435-446
Number of pages12
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Volume18
Issue number4
DOIs
Publication statusPublished - Aug 2018

Keywords

  • Albumins/administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols/administration & dosage
  • Cost-Benefit Analysis
  • Deoxycytidine/administration & dosage
  • Disease-Free Survival
  • Humans
  • Italy
  • Markov Chains
  • Neoplasm Metastasis
  • Paclitaxel/administration & dosage
  • Pancreatic Neoplasms/drug therapy
  • Quality-Adjusted Life Years

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