3424 - Cost-Effectiveness of Comprehensive Metastasis Directed Therapy in Patients with Oligometastatic Pancreatic Ductal Adenocarcinoma

Purpose/Objective(s): While outcomes after initial chemotherapy for metastatic pancreatic ductal adenocarcinoma (PDAC) are poor, patients with limited metastatic disease may have improved outcomes with addition of comprehensive metastasis-directed therapy (MDT). Recently, a randomized trial found the addition of MDT, as compared to systemic therapy alone, may reduce the risk of progression and increase likelihood of a chemotherapy break in patients with oligometastatic PDAC. Given the prevalence of metastatic PDAC, it is imperative we understand its financial impact of this treatment paradigm. Here, we evaluated the cost-effectiveness of addition of MDT to systemic therapy for oligometastatic PDAC.

Materials/Methods: We built a microsimulation model for patients with oligometastatic PDAC who received a combination of systemic therapy and MDT or systemic therapy alone. The model incorporates costs, quality of life (measured by health utility), and probabilities of chemotherapy break, progression, and death. We extracted probabilities of chemotherapy break, progression, and death from a phase II randomized trial of addition of MDT to systemic therapy, and health utilities from published literature. We assessed costs from the healthcare payer perspective. We measured cost-effectiveness with the incremental cost-effectiveness ratio (ICER) with ICERs less than $150,000 per quality-adjusted life-year (QALY) considered cost-effective. One-way and probabilities sensitivity analyses were used to test model uncertainty.

Results: Simulating the clinical course of 1,000,000 patients with oligometastatic PDAC, we found that compared to systemic therapy alone, addition of MDT increased overall cost by $19,201 and improved effectiveness by 0.17 QALYs, resulting in an ICER of $109,800/QALY. The model was most sensitive to assumptions about cost of MDT, risk of progression, and health utility of stable disease. If the cost of MDT increased from our base estimate of $15,211 to $22,254, the hazard ratio of progression-free-survival increased from our estimate of 0.43 to 0.55, or the health utility of stable disease decreased from our estimate of 0.68 to 0.48 then MDT was no longer cost effective (ICER >$150,000/QALY). The model was not sensitive to assumptions about the monthly cost of cancer care, cost of chemotherapy, or probability of chemotherapy break. Probabilistic sensitivity analysis demonstrated that addition of MDT was cost-effective in >99% of iterations.

Conclusion: This study found that addition of comprehensive MDT to systemic therapy may represent a cost-effective treatment option by reducing risk of progression among patients with oligometastatic PDAC. Longer follow-up and additional research further defining efficacy of MDT for oligometastatic PDAC will help confirm these findings.