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Cost-effectiveness analysis of adjuvant treatment for resected pancreatic cancer in China based on the ESPAC-4 trial

Authors Huang J, Liao W, Zhou J, Zhang P, Wen F, Wang X, Zhang M, Zhou K, Wu Q, Li Q

Received 30 April 2018

Accepted for publication 24 July 2018

Published 1 October 2018 Volume 2018:10 Pages 4065—4072

DOI https://doi.org/10.2147/CMAR.S172704

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Professor Nakshatri


Jiaxing Huang,1,2,* Weiting Liao,1,2,* Jing Zhou,1,2 Pengfei Zhang,1,2 Feng Wen,1,2 Xinyuan Wang,1,2 Mengxi Zhang,1,2 Kexun Zhou,1,2 Qiuji Wu,1,2 Qiu Li1,2

1Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; 2West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China

*These authors contributed equally to this work

Background: The effectiveness of gemcitabine plus capecitabine compared with gemcitabine monotherapy for resected pancreatic cancer has been evaluated in the ESPAC-4 trial. We aimed to assess the cost-effectiveness of these adjuvant regimens on resected pancreatic cancer.
Methods: A Markov model was established to simulate the disease process of resected pancreatic cancer (relapse-free survival, progressive disease, and death). The efficacy and toxicity profiles were collected from the ESPAC-4 trial. Transition probabilities were calculated based on survival in each group. Cost data were calculated from the perspective of the Chinese healthcare payer. The primary endpoint in the analysis was the incremental cost-effectiveness ratio (ICER), and model uncertainties were explored by one-way sensitivity analysis and probabilistic sensitivity analysis.
Results: Our results demonstrated that gemcitabine monotherapy cost $36,028.45 and yielded a survival of 1.02 quality-adjusted life year (QALY), while gemcitabine plus capecitabine cost $46,095.05 and yielded a survival of 1.23 QALY. Therefore, the incremental cost-effectiveness ratio of gemcitabine plus capecitabine vs gemcitabine monotherapy was $45,191.23 which surpassed the willingness-to-pay threshold of $29,291.42 per QALY in China.
Conclusion: The gemcitabine monotherapy regimen is more cost-effective compared with gemcitabine plus capecitabine regimen for the patients with postoperative pancreatic cancer from the Chinese societal perspective.

Keywords: cost-effectiveness, Markov model, gemcitabine, capecitabine, resected pancreatic cancer

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