Estimating the cost-effectiveness of tumor treating fields for locally advanced pancreatic cancer patients.

内容摘要

Locally advanced pancreatic cancer (LAPC) is associated with limited survival, high symptom burden, and few therapeutic innovations. The PANOVA-3 trial evaluated Tumor Treating Fields (TTFields) therapy applied with gemcitabine plus nab-paclitaxel (GnP) for first-line treatment of LAPC, demonstrating improved overall survival (OS), distant progression-free survival (PFS), and time to pain progression. We conducted a cost-utility analysis to evaluate the economic value of TTFields + GnP relative to GnP alone. A partitioned survival model was developed using trial-based Kaplan-Meier curves for OS, distant progression-PFS, and time to pain progression. Model inputs reflected the intent-to-treat (ITT) population from PANOVA-3, with health utilities, resource use, and costs obtained from published U.S. sources. Disutility for pain was applied during time after pain worsening to capture quality-of-life decrement. Costs and outcomes were discounted at 3% annually, and analyses were conducted from a U.S. payer perspective. Deterministic, probabilistic, and scenario analyses explored uncertainty in key assumptions and model structure. TTFields + GnP increased discounted lifetime costs to $351,400 vs. $220,000 for GnP alone, with an incremental gain of 0.34 QALYs and an ICER of $387,300 per QALY. Approximately 0.03 QALYs were attributable to reduced time lived with pain. Sensitivity analyses identified TTFields therapy cost and treatment duration as primary drivers of the ICER. Scenario analyses produced ICERs ranging from $391,800 to $547,200 per QALY. TTFields + GnP improves survival and delays pain progression in LAPC, generating measurable gains in quality-adjusted survival. Resulting ICERs should be interpreted in the context of a disease with high unmet need, poor prognosis, and limited therapeutic options; factors that support a broader assessment of value beyond conventional cost-effectiveness thresholds. The multidimensional benefits observed, including quality-of-life gains, reinforce the case for TTFields therapy in LAPC and highlight the importance of incorporating such endpoints into economic evaluations of late-stage cancers. Locally advanced pancreatic cancer is a serious form of pancreatic cancer that has grown into nearby blood vessels and usually cannot be removed by surgery when it is diagnosed, although a minority of patients may become candidates for surgery after initial chemotherapy. People with this disease typically live about one to one-and-a-half years and often experience significant pain, and no new treatment had shown a meaningful benefit in this group in over a decade. Tumor Treating Fields (TTFields) is a non-drug treatment worn on the skin that uses electrical fields to interfere with cancer cell growth. In a large clinical trial, adding TTFields to standard chemotherapy helped patients live longer and delayed both cancer growth and the worsening of pain, compared with chemotherapy alone. We built an economic model estimating the added cost and health benefit of TTFields plus chemotherapy versus chemotherapy alone, from a U.S. healthcare payer’s perspective, using “quality-adjusted life years” (QALYs), a measure combining survival time and quality of life. TTFields increased both survival and quality-adjusted survival, including extra time before pain worsened, but at substantially higher cost, about $131,400 more per patient, or roughly $387,300 per additional QALY gained. This exceeds the range U.S. decision-makers typically consider good value ($100,000–$150,000 per QALY), though this must be weighed against the severity of the disease, limited treatment options, and TTFields’ unique combined survival and quality-of-life benefit.