Cost-Effectiveness of Daraxonrasib vs Chemotherapy in Previously Treated Metastatic Pancreatic Adenocarcinoma
- 1Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine
Abstract
IntroductionDaraxonrasib is the first broad RAS-targeted medicine approved for metastatic pancreatic adenocarcinoma. In RASolute 302, it approximately doubled median overall survival in the prespecified RAS G12 population. The US wholesale acquisition cost (WAC) is $39,800 per 30-day supply. Contemporary oncology launch prices have risen substantially, and many recently launched drugs have been priced above value-based benchmarks. The value of a genuinely transformative oncology therapy at this price is uncertain.
ObjectiveTo estimate the cost-effectiveness of daraxonrasib compared with investigators-choice chemotherapy in previously treated metastatic pancreatic adenocarcinoma using publicly available clinical and economic data.
Design, Setting, and ParticipantsEconomic evaluation using a 3-state partitioned survival model informed by the international randomized phase 3 RASolute 302 trial. Published Kaplan-Meier curves and numbers at risk were used to reconstruct pseudo-individual patient data. The RAS G12 population (n=459), corresponding to the trials dual primary efficacy end points, was the primary economic population; the overall randomized population (n=500) was analyzed in parallel. Analyses were conducted in 2026 from a US health sector perspective.
Exposures: Daraxonrasib 300 mg orally once daily versus investigators-choice chemotherapy, weighted to the observed trial regimen distribution.
Main Outcomes and MeasuresIncremental life-years, quality-adjusted life-years (QALYs), costs, incremental cost-effectiveness ratio (ICER), incremental net monetary benefit, and the 30-day daraxonrasib price consistent with willingness-to-pay thresholds of $100,000, $150,000, $200,000, and $255,000/QALY. Costs were expressed in 2026 US dollars and discounted at 3% annually.
ResultsIn the RAS G12 population, daraxonrasib generated 0.652 additional life-years and 0.506 additional QALYs at an incremental cost of $253,171, yielding an ICER of $500,637/QALY. The corresponding overall-population ICER was $542,255/QALY. A 10-year horizon changed the RAS G12 ICER to $497,270/QALY; using curve-specific distributions selected by Akaike information criterion produced $493,895/QALY. In 5000 probabilistic simulations, the probability of cost-effectiveness was 0% at $150,000 and $200,000/QALY and 0.1% at $255,000/QALY. Threshold prices in the RAS G12 population were $14,060 per 30 days at $150,000/QALY and $17,730 at $200,000/QALY, reductions of 64.7% and 55.5% from WAC. An independent secondary implementation using separately digitized survival curves and piecewise-exponential extrapolation produced a higher ICER; after calibrating drug exposure to observed treatment duration, the estimate remained approximately $676,000/QALY, with most of the difference attributable to the extrapolated treatment-exposure tail.
Conclusions and RelevanceDaraxonrasib nearly doubled median overall survival in previously treated metastatic pancreatic adenocarcinoma, in which median survival with standard chemotherapy was about 7 months, and should remain available to eligible patients. At WAC, daraxonrasib costs approximately $500,000 per QALY, well above conventional US benchmarks. Because actual net acquisition prices may reflect confidential discounts or rebates, the ICER based on WAC may exceed the ICER at the net price. Threshold list prices consistent with 150,000−200,000/QALY were 14,060−17,730 per 30 days (a 55%-65% reduction from WAC), offered as reference points for pricing and coverage discussions rather than recommended prices.
Related
- Efficacy and Safety of Daraxonrasib (RMC-6236) in Previously Treated Metastatic RAS-Mutated Pancreatic Ductal Adenocarcinoma: A Systematic Review.
- Evaluation of clinical outcomes and prognostic factors in patients with metastatic appendiceal adenocarcinoma treated with first-line chemotherapy: A multi-institutional retrospective study
- Combined halp and GRIm scores for risk stratification in metastatic pancreatic ductal adenocarcinoma
- Exceptionally Durable Response to First-Line S-1 Monotherapy in Metastatic Pancreatic Adenocarcinoma: A Case Report
- Metastatic Lung Adenocarcinoma to the Uterus Mimicking a Primary Uterine Malignancy: A Case Report
BibTeX
@misc{han2026costeffectiveness,
title = {{Cost-Effectiveness of Daraxonrasib vs Chemotherapy in Previously Treated Metastatic Pancreatic Adenocarcinoma}},
author = {S. Han and N. Starasvetskaya and G. Terrero and P. Hosein and G. de Lima Lopes Junior},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.16.26363246},
url = {https://www.medrxiv.org/content/10.64898/2026.09.16.26363246v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Cost-Effectiveness of Daraxonrasib vs Chemotherapy in Previously Treated Metastatic Pancreatic Adenocarcinoma
AU - S. Han
AU - N. Starasvetskaya
AU - G. Terrero
AU - P. Hosein
AU - G. de Lima Lopes Junior
PY - 2026
DA - 2026/09/16
PB - medRxiv
DO - 10.64898/2026.09.16.26363246
UR - https://www.medrxiv.org/content/10.64898/2026.09.16.26363246v1
AB - IntroductionDaraxonrasib is the first broad RAS-targeted medicine approved for metastatic pancreatic adenocarcinoma. In RASolute 302, it approximately doubled median overall survival in the prespecified RAS G12 population. The US wholesale acquisition cost (WAC) is $39,800 per 30-day supply. Contemporary oncology launch prices have risen substantially, and many recently launched drugs have been priced above value-based benchmarks. The value of a genuinely transformative oncology therapy at this price is uncertain. ObjectiveTo estimate the cost-effectiveness of daraxonrasib compared with investigators-choice chemotherapy in previously treated metastatic pancreatic adenocarcinoma using publicly available clinical and economic data. Design, Setting, and ParticipantsEconomic evaluation using a 3-state partitioned survival model informed by the international randomized phase 3 RASolute 302 trial. Published Kaplan-Meier curves and numbers at risk were used to reconstruct pseudo-individual patient data. The RAS G12 population (n=459), corresponding to the trials dual primary efficacy end points, was the primary economic population; the overall randomized population (n=500) was analyzed in parallel. Analyses were conducted in 2026 from a US health sector perspective. Exposures: Daraxonrasib 300 mg orally once daily versus investigators-choice chemotherapy, weighted to the observed trial regimen distribution. Main Outcomes and MeasuresIncremental life-years, quality-adjusted life-years (QALYs), costs, incremental cost-effectiveness ratio (ICER), incremental net monetary benefit, and the 30-day daraxonrasib price consistent with willingness-to-pay thresholds of $100,000, $150,000, $200,000, and $255,000/QALY. Costs were expressed in 2026 US dollars and discounted at 3% annually. ResultsIn the RAS G12 population, daraxonrasib generated 0.652 additional life-years and 0.506 additional QALYs at an incremental cost of $253,171, yielding an ICER of $500,637/QALY. The corresponding overall-population ICER was $542,255/QALY. A 10-year horizon changed the RAS G12 ICER to $497,270/QALY; using curve-specific distributions selected by Akaike information criterion produced $493,895/QALY. In 5000 probabilistic simulations, the probability of cost-effectiveness was 0% at $150,000 and $200,000/QALY and 0.1% at $255,000/QALY. Threshold prices in the RAS G12 population were $14,060 per 30 days at $150,000/QALY and $17,730 at $200,000/QALY, reductions of 64.7% and 55.5% from WAC. An independent secondary implementation using separately digitized survival curves and piecewise-exponential extrapolation produced a higher ICER; after calibrating drug exposure to observed treatment duration, the estimate remained approximately $676,000/QALY, with most of the difference attributable to the extrapolated treatment-exposure tail. Conclusions and RelevanceDaraxonrasib nearly doubled median overall survival in previously treated metastatic pancreatic adenocarcinoma, in which median survival with standard chemotherapy was about 7 months, and should remain available to eligible patients. At WAC, daraxonrasib costs approximately $500,000 per QALY, well above conventional US benchmarks. Because actual net acquisition prices may reflect confidential discounts or rebates, the ICER based on WAC may exceed the ICER at the net price. Threshold list prices consistent with 150,000−200,000/QALY were 14,060−17,730 per 30 days (a 55%-65% reduction from WAC), offered as reference points for pricing and coverage discussions rather than recommended prices.
ER -