Cost-effectiveness analysis of liposomal irinotecan in combination with oxaliplatin, 5-fluorouracil and leucovorin (NALIRIFOX) for the first-line treatment of adult patients with metastatic adenocarcinoma of the pancreas in Greece

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OBJECTIVE: To evaluate the cost-effectiveness of liposomal Irinotecan (Onivyde) in combination with oxaliplatin, 5-fluorouracil and leucovorin (NALIRIFOX) compared to gemcitabine plus nab-paclitaxel (GemNabPac), for the first-line treatment (FLT) of adult patients with metastatic adenocarcinoma of the pancreas (mPDAC) in Greece. METHODS: A partitioned survival model was adapted from a Greek payer perspective over a lifetime horizon. GemNabPac was selected as the comparator, representing the current standard of care in Greece. Clinical efficacy, safety, and utilities were derived from the NAPOLI-3 trial and published literature. Direct medical costs reflecting the year 2026 were included in the analysis. Model outcomes included quality-adjusted life years (QALYs), life years (LYs), total costs, and incremental cost-effectiveness ratios (ICERs). RESULTS: The analysis showed that NALIRIFOX was associated with incremental gains of 0.14 QALYs and 0.16 LYs compared with GemNabPac, at an additional cost of €8,571. The resulting ICERs were €62,810 per QALY gained and €54,326 per LY gained. CONCLUSION: The present study indicates that NALIRIFOX provides clinically meaningful benefits and may represent a cost-effective option for patients with mPDAC in Greece, a population with very limited FLT options, under the assumptions and threshold used.

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