Pancreatic cancer in Algeria – Cost-effectiveness study: A Comparative Study of FOLFIRINOX and GEMCITABINE Protocols

Abstract

Pancreatic cancer is a formidable disease, often diagnosed at an advanced stage, with poor overall survival. Advances in therapeutic protocols have improved tumor response rates in certain situations, but at the cost of high expenses and significant adverse effects. In the absence of local guidelines, a cost-effectiveness evaluation is essential to guide therapeutic decisions, particularly in resource-limited countries.

To compare efficacy, toxicity and real-world direct medical costs of FOLFIRINOX versus gemcitabine-based regimens in routine practice at EHU Oran, Algeria. This is a prospective descriptive observational study conducted in the Medical Oncology Department of the EHU Oran between October 2020 and December 2023. All patients with pancreatic cancer, regardless of stage, were included. The analyzed protocols were FOLFIRINOX and GEMCITABINE, used in neoadjuvant or palliative settings. Tumor response criteria (RECIST v1.1), toxicity (CTCAE v4.0), and economic data (total cost over 6 months, cost per cycle) were systematically collected. Of the 133 patients included, 42 received neoadjuvant chemotherapy (14 FOLFIRINOX, 13 GEMCITABINE), and 77 received palliative treatment (18 FOLFIRINOX, 25 GEMCITABINE). Response rates with FOLFIRINOX were higher than with GEMCITABINE in both settings (37.5% vs. 12.5% in neoadjuvant, 35.7% vs. 28.5% in palliative). However, the average cost of a complete 6-month treatment was estimated at 360,000 DA for FOLFIRINOX, compared to 35,100 DA for GEMCITABINE. The addition of supportive treatments such as Eprex did not alter this trend. Our results demonstrate that, although FOLFIRINOX is more effective in terms of tumor response, its high cost and toxicity limit its routine use, particularly in elderly or frail patients. Systematic use of a multidisciplinary tumor board (RCP) enables the selection of patients likely to benefit from it. This study, the first of its kind in Algeria, highlights the importance of combining clinical and economic criteria to tailor therapeutic strategies to individual patients.

Pancreatic cancer represents a major public health challenge in Algeria. Integrating cost-effectiveness evaluations into clinical practice is a valuable decision-making tool. Multicentric studies are needed to validate these findings on a larger scale and guide future national recommendations.