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Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer

Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
Health Outcomes and Pharmacoeconomics (hope) Research Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Division of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON, Canada
Author to whom correspondence should be addressed.
Curr. Oncol. 2013, 20(2), 90-106;
Submission received: 6 March 2013 / Revised: 8 March 2013 / Accepted: 13 March 2013 / Published: 1 April 2013


Purpose: Gemcitabine and capecitabine (gem-cap), gemcitabine and erlotinib (gem-e), and folfirinox (5-fluorouracil–leucovorin–irinotecan–oxaliplatin) are new treatment options for metastatic pancreatic cancer, but they are also more expensive and potentially more toxic than gemcitabine alone (gem). We conducted a cost-effectiveness analysis of these treatment options compared with gem. Methods: A Markov model was constructed to examine costs and outcomes of gem-cap, gem-e, folfirinox, and gem in patients with metastatic pancreatic cancer from the perspective of a government health care plan. Ontario health economic and costing data (2010 Canadian dollars) were used. Efficacy data for the treatments were obtained from the published literature. Resource utilization data were derived from a chart review of consecutive metastatic patients treated for pancreatic cancer at Princess Margaret Hospital, Toronto, Ontario, 2008–2009, and supplemented with data from the literature. Utilities were obtained by surveying medical oncologists across Canada using the EQ-5D. Incremental cost-effectiveness ratios (icers) were calculated. Results: The icers for gem-cap, gem-e, and folfirinox compared with gem were, respectively, CA$84,299, CA$153,631, and CA$133,184 per quality-adjusted life year (qaly). The model was driven mostly by drug acquisition costs. Given a willingness-to-pay (wtp) threshold greater than CA$130,000/qaly, folfirinox was most cost-effective treatment. When the wtp threshold was less than CA$80,000/qaly, gem alone was most cost-effective. The gem-e option was dominated by the other treatments. Conclusions: The most cost-effective treatment for metastatic pancreatic cancer depends on the societal wtp threshold. If the societal wtp threshold were to be relatively high or if drug costs were to be substantially reduced, folfirinox might be cost-effective.
Keywords: pancreatic cancer; cost-effectiveness; chemotherapy pancreatic cancer; cost-effectiveness; chemotherapy

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MDPI and ACS Style

Tam, V.C.; Ko, Y.J.; Mittmann, N.; Cheung, M.C.; Kumar, K.; Hassan, S.; Chan, K.K.W. Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer. Curr. Oncol. 2013, 20, 90-106.

AMA Style

Tam VC, Ko YJ, Mittmann N, Cheung MC, Kumar K, Hassan S, Chan KKW. Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer. Current Oncology. 2013; 20(2):90-106.

Chicago/Turabian Style

Tam, V.C., Y.J. Ko, N. Mittmann, M.C. Cheung, K. Kumar, S. Hassan, and K.K.W. Chan. 2013. "Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer" Current Oncology 20, no. 2: 90-106.

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