Cost-effectiveness of Gemcitabine Plus Modern Radiotherapy in Locally Advanced Pancreatic Cancer

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• 作者：Henry W.C. Leung ; MD ; MBA¹ ; ² ; Agnes L.F. Chan ; PhD ; MAMM ; BScPharm³ ; ⁴ ; ^{agnes.lf@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Chih-Hsin Muo ; MD⁵
• 关键词：cost-effectiveness ; economic evaluation ; locally advanced pancreatic cancer ; stereotactic body radiotherapy
• 刊名：Clinical Therapeutics
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：38
• 期：5
• 页码：1174-1183
• 全文大小：280 K

文摘

The purpose of this study was to evaluate the cost-effectiveness of gemcitabine plus modern radiotherapy versus gemcitabine alone in the treatment of locally advanced pancreatic cancer in Taiwan.

Methods

A Markov decision-analytic model was performed to compare the cost-effectiveness of 3 treatment regimens; gemcitabine alone (gem-alone), gemcitabine plus intensity-modulated radiotherapy (gem-IMRT), and gemcitabine plus stereotactic body radiotherapy (gem-SBRT). Patients transitioned between 5 health states: stable disease, local progression, distant metastasis, local and distant metastasis, and death.

Findings

The incremental cost-effectiveness ratio for gem-IMRT and gem-SBRT compared with gem-alone were NT$27,120,168 and NT$2,145,683 per quality-adjusted life-year gained, respectively. A willingness to pay threshold of 3 times the per capita gross domestic product was adopted according to the definition of the World Health Organization. The Taiwan per capita gross domestic product in 2015 was NT$673,920 (US$22,464; 1 NT$ = US$0.03333 in Taiwan); thus, a threshold was considered as NT$2,021,760 (US$67,392). The Monte-Carlo simulation found that the probability of cost-effectiveness at a willingness to pay threshold of NT$2,021,760 per quality-adjusted life-year was 0% chance for gem-IMRT and 50% for gem-SBRT.

Implications

This study indicated that gem-IMRT or gem-SBRT in locally advanced pancreatic cancer is not cost-effective at a willingness to pay as defined by World Health Organization guideline in Taiwan.