Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile .
There is no clear evidence to support one regimen over another .
PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer .
Using economic analysis to evaluate the potential of multimodality therapy for elderly patients with locally advanced pancreatic cancer.
PURPOSE Development of new and expensive drugs with activity against pancreatic cancer has made economic considerations more relevant to treatment decision-making for advanced disease . Economic modeling can be used to explore the potential of such novel therapies and to inform clinical trial design . METHODS AND MATERIAL S We developed a Markov model to evaluate the cost-effectiveness of radiation plus fluorouracil ( RT-FU ) relative to no treatment in elderly patients with locally advanced pancreatic cancer ( LAPC ) and to determine the economic potential of radiation plus gemcitabine ( RT-GEM ) , a novel regimen for this disease . We used the SEER-Medicare data base to estimate effectiveness and costs supplemented by data from the literature where necessary . RESULTS Relative to no treatment , RT-FU was associated with a cost-effectiveness ratio ( ICER ) of $ 68,724/QALY in the base case analysis . Compared with RT-FU , the ICER for RT-GEM was below $ 100,000/QALY when the risk of dying with the new regimen was < 85 % than with the st and ard regimen . However , > 1,000 subjects would be necessary to demonstrate this level of efficacy in a r and omized trial . The ICER of RT-GEM was most sensitive to utility values , and , at lower efficacy levels , to costs of gemcitabine and treatment-related toxicity . CONCLUSIONS In elderly patients with LAPC , RT-FU is a cost-effective alternative to no treatment . The novel regimen of RT-GEM is likely to be cost-effective at any clinical ly meaningful benefit , but quality -of-life issues , drug acquisition , and toxicity-related costs may be relevant , especially at lower efficacy levels
Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile .
There is no clear evidence to support one regimen over another .
PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer .