A cost-utility analysis of gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer.
Bibliographic record
Abstract
e17569 Background: FOLFIRINOX has been shown to be superior to gemcitabine (gem) alone for metastatic pancreatic cancer (MPC) and has been established as the standard of care. A recent study (von Hoff et al, GI ASCO 2013) showed that gem + nab-paclitaxel (gem+nab-p) was superior to gem alone. The cost-effectiveness of gem+nab-p relative to gem or FOLFIRINOX has not been studied. Methods: A Markov cohort model was constructed for patients with MPC to examine the costs and outcomes of gem alone, gem+nab-p and FOLFIRINOX. Efficacy and side-effect data were obtained from pivotal phase III trials. Resource utilization data, unit costs and utilities were obtained from Ontario Ministry of Health and Long-Term Care, Sunnybrook Health Sciences Centre and the literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) defined as cost per quality-adjusted life year (QALY). The analysis was conducted from the perspective of the Canadian public healthcare system over a 2-year time horizon adjusted to 2012 Canadian dollars (CAD$). Both cost and effectiveness were discounted at 5%. One way and probabilistic sensitivity analyses were performed. Results: Using gem as the base case, gem+nab-p had better outcomes but higher costs (see Table). The ICER was higher than conventional willingness-to-pay (WTP) threshold. Gem+nab-p was less effective but less costly when compared with FOLFIRINOX. It was dominated by combinations of gem and FOLFIRINOX (i.e. extended dominance), and therefore not cost-effective regardless of WTP threshold. If the price of nab-p was 20% lower, then gem+nab-p and FOLFORINOX would have similar cost-effectiveness. Conclusions: Gem+nab-p is not cost-effective, from the Canadian perspective, for the treatment of MPC based on the current price when compared with FOLFIRINOX. A lower-priced generic oxaliplatin, which is available in some jurisdictions including the United States, may affect the outcome of this analysis in further favor of FOLFIRINOX. [Table: see text]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.015 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".