Outpatient Services Drive Health Care Costs for Patients With Metastatic Pancreatic Cancer

Findings from a study found that health care costs for patients with metastatic pancreatic ductal adenocarcinoma who received treatment with nab-paclitaxel and gemcitabine or fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) are driven mostly by outpatient costs (J Manag Care Spec Pharm. 2020;26[7]:872-878. doi:10.18553/jmcp.2020.26.7.872).

“Management of metastatic pancreatic ductal adenocarcinoma… places a significant financial burden on the US health care system because of such factors as treatment with multidrug chemotherapy regimens, management of chemotherapy-related adverse events, and disease- or treatment-related hospitalizations,” explained Andrea Bullock , MD, MPH, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and colleagues.

Noting a lack of prior studies assessing the overall health care costs associated with the management of metastatic pancreatic adenocarcinoma, Dr Bullock and colleagues conducted this study to describe the health care costs following initiation of first-line treatment with nab-paclitaxel and gemcitabine or FOLFIRINOX.

Retrospective cohorts were derived from the MarketScan database from 2014 to 2017. The index date noted as the date of initiation of first-line treatment. Eligible patients had insurance enrollment for 6 months before the index date.

Dr Bullock and colleagues assessed total cumulative health care costs and costs from outpatient services, inpatient admissions, emergency department visits, chemotherapy administrations, and pharmacy dispensing within 12 months after the index date. Patient-level cost data began accruing from the first paid claim and continued accruing until the censoring date.

A total of 2199 patients who initiated first-line nab-paclitaxel and gemcitabine (n = 1352) or FOLFIRINOX (n = 847) were included in the study.

Median follow-up was 5.4 months for those who receive nab-paclitaxel and gemcitabine compared with 7.2 months for FOLFIRINOX. Median first-line treatment duration was 2.1 months and 2.3 months, respectively.

The median total cumulative health care costs 6 months following treatment initiation were $85,714 (95% CI = $79,683-$91,788) for nab-paclitaxel and gemcitabine and $114,116 (95% CI = $105,816-$119,591) for FOLFIRINOX. 

“Total health care costs for patients with mPDA [metastatic pancreatic adenocarcinoma] who initiated FFX [FOLFIRINOX] or AG [nab-paclitaxel plus gemcitabine] are driven mostly by outpatient rather than inpatient costs,” Dr Bullock and colleagues concluded.—Janelle Bradley

Source: Journal of Clinical Pathways By: Janelle Bradley

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