S-1 or gemcitabine adjuvant therapy in resected pancreatic cancer: a cost-effectiveness analysis based on the JASPAC-01 trial

ABSTRACT

Purpose

This study aimed to investigate the cost-effectiveness of adjuvant treatments in resected pancreatic cancer.

Methods

A Markov model was developed to mimic the disease process of postoperative pancreatic cancer, encompassing three health states (relapse-free survival, recurrent disease, and death). Health outcomes and utility scores were derived from the phase III trial and available literature. Cost data were calculated using standard fee data from the West China Hospital for 2017. One-way sensitivity analyses and probabilistic sensitivity analyses were developed to explore model uncertainty.

Results

Treatment with S-1 was estimated to yield 1.61 quality-adjusted life-years (QALYs) at a cost of $25,696, whereas treatment with gemcitabine yielded 1.27 QALYs at a cost of $28,930. The incremental cost-effectiveness ratio of S-1 versus gemcitabine was $-9,490 per QALY. Based on the willingness-to-pay threshold of $25,841 per QALY, the net monetary benefit (NMB) was $15,786 for S-1 and $3,727 for gemcitabine, generating the incremental NMB of $12,059. A probabilistic sensitivity analysis revealed that the probabilities of S-1 and gemcitabine being cost-effective were 92% and 8%, respectively. Results were robust to changes in parameters.

Conclusion

Adjuvant therapy using S-1 is a cost-effective alternative compared to gemcitabine in patients with postoperative pancreatic cancer from the Chinese societal perspective.

KEYWORDS:

• Cost-effectiveness
• pancreatic cancer
• adjuvant therapy
• postoperative
• 5-fluorouracil
• gemcitabine
• JASPAC-01 trial

Article highlights

• Pancreatic cancer is a highly fatal disease, and its financial burden remains considerable.

• S-1 produced an incremental 0.34 QALYs at an incremental cost of $-3,234 compared with gemcitabine, yielding the incremental cost-effectiveness ratio of $-9,490 per QALY.

• S-1 could represent a more cost-effective adjuvant therapy compared with gemcitabine for postoperative pancreatic cancer in the Chinese setting.

• According to the cost evidence available, S-1 accompanies competitive edges with regard to cheaper price, hospitalization, administration fees, and societal costs.

• Further researches are expected to explore the optimal dose and schedule of S-1 in non-East-Asian patients and to broad the pool of cancer patients those may benefit from S-1.

Acknowledgments

The authors would like to thank Prof. PhD. David W. Hutton from the Department of Health Management and Policy, University of Michigan for his valuable discussions about this study.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author Contributions

Li Q and Gou HF conceived the idea. Liao WT and Huang JX collected the data, developed the model and wrote the paper. Zhu GQ, Zhou J, Wen F, Zhang PF, Zhou KX, Wu QJ, Wang XY participated, reviewed and edited the manuscript. All authors read and approved the manuscript.

Supplementary material

Supplemental data for this article can be accessed here.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The National Natural Science Foundation of China [General Program: 81572988] and the Science & Technology Department of Sichuan Province Funding Project [No.2016FZ0108, 2018SZ0117].