Costs of First-Line Treatment With FOLFIRINOX, Modified FOLFIRINOX, and Gemcitabine With Nab-Paclitaxel in Metastatic Pancreatic Ductal Adenocarcinoma.

IF 2.3 Q2 ECONOMICS

Journal of Health Economics and Outcomes Research Pub Date : 2025-08-22 eCollection Date: 2025-01-01 DOI:10.36469/001c.142403

Syvart Dennen, Marty Masek, Paul Cockrum, Elizabeth Nagelhout, Ravi Paluri

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Total all-cause costs included costs from inpatient, outpatient, chemotherapy drug and administration, granulocyte colony-stimulating factor (G-CSF), radiation therapy, and other outpatient and pharmacy costs.Results: A total of 3115 patients met the criteria for inclusion and received 1L treatment with either FFX, mFFX, or GnP. Among those, 1703 had commercial insurance (FFX, 536; mFFX, 673; GnP, 494) and 1412 had Medicare Advantage (FFX, 201; mFFX, 317; GnP, 894). Total cost of care (mean [SD]) was similar between regimens for each insurance cohort (mean [SD] commercial: FFX, <math><mn>137</mn> <mrow><mo> </mo></mrow> <mn>813</mn> <mo>[</mo></math> 127 504]; mFFX, <math><mn>120</mn> <mrow><mo> </mo></mrow> <mn>109</mn> <mo>[</mo></math> 112 208]; GnP, <math><mn>133</mn> <mrow><mo> </mo></mrow> <mn>042</mn> <mo>[</mo></math> 154 248]; Medicare Advantage: FFX, <math><mn>110</mn> <mrow><mo> </mo></mrow> <mn>788</mn> <mo>[</mo></math> 98 492]; mFFX, <math><mn>98</mn> <mrow><mo> </mo></mrow> <mn>667</mn> <mo>[</mo></math> 83 437]; GnP, <math><mn>110</mn> <mrow><mo> </mo></mrow> <mn>211</mn> <mo>[</mo></math> 100 150]). For both insurance cohorts, chemotherapy drug costs were highest for GnP (mean [SD] commercial: FFX, <math><mn>10</mn> <mrow><mo> </mo></mrow> <mn>916</mn> <mo>[</mo></math> 21 647]; mFFX, <math><mn>7653</mn> <mo>[</mo></math> 10 054]; GnP, <math><mn>60</mn> <mrow><mo> </mo></mrow> <mn>466</mn> <mo>[</mo></math> 112 589]; Medicare Advantage: FFX, <math><mn>8028</mn> <mo>[</mo></math> 11 044]; mFFX, <math><mn>6016</mn> <mo>[</mo></math> 7688]; GnP, <math><mn>49</mn> <mrow><mo> </mo></mrow> <mn>263</mn> <mo>[</mo></math> 49 373]), while chemotherapy administration costs were higher for FFX and mFFX (commercial: FFX, <math><mn>25</mn> <mrow><mo> </mo></mrow> <mn>458</mn> <mo>[</mo></math> 33 350]; mFFX, <math><mn>22</mn> <mrow><mo> </mo></mrow> <mn>795</mn> <mo>[</mo></math> 24 309]; GnP <math><mn>12</mn> <mrow><mo> </mo></mrow> <mn>206</mn> <mo>[</mo></math> 15 766]; Medicare Advantage: FFX, <math><mn>25</mn> <mrow><mo> </mo></mrow> <mn>512</mn> <mo>[</mo></math> 36 352]; mFFX, <math><mn>21</mn> <mrow><mo> </mo></mrow> <mn>524</mn> <mo>[</mo></math> 22 317]; GnP <math><mn>11</mn> <mrow><mo> </mo></mrow> <mn>103</mn> <mo>[</mo></math> 13 089]). G-CSF costs were also higher for FFX and mFFX (commercial: FFX, <math><mn>38</mn> <mrow><mo> </mo></mrow> <mn>074</mn> <mo>[</mo></math> 56 593], mFFX, <math><mn>27</mn> <mrow><mo> </mo></mrow> <mn>823</mn> <mo>[</mo></math> 41 166]; GnP, <math><mn>4029</mn> <mo>[</mo></math> 14 181]; Medicare Advantage: FFX, <math><mn>30</mn> <mrow><mo> </mo></mrow> <mn>535</mn> <mo>[</mo></math> 56 630]; mFFX, <math><mn>24</mn> <mrow><mo> </mo></mrow> <mn>596</mn> <mo>[</mo></math> 39 286]; GnP, <math><mn>2412</mn> <mo>[</mo></math> 9115]).Discussion: Total costs of 1L FFX, mFFX, and GnP were similar within a commercially insured and Medicare Advantage cohort. FFX and mFFX costs were largely driven by chemotherapy administration and G-CSF costs, while GnP costs were driven by chemotherapy drug costs.Conclusions: To fully assess the economic impact of mPDAC in 1L treatment, it is essential to consider both the total cost and the individual cost components, such as chemotherapy drugs, administration, and supportive care costs.","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"75-84"},"PeriodicalIF":2.3000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375408/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health Economics and Outcomes Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.36469/001c.142403","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ECONOMICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Further research is needed to determine real-world costs of first-line (1L) treatment of metastatic pancreatic ductal adenocarcinoma (mPDAC) with FOLFIRINOX (FFX), modified FFX (mFFX), and gemcitabine with nab-paclitaxel (GnP).

Objectives: To describe healthcare costs by treatment regimen, stratified by commercial and Medicare Advantage insurance.

Methods: This retrospective cohort study of adult patients with mPDAC utilized Optum's de-identified Market Clarity Dataset. Demographics, clinical characteristics, and 1L unadjusted all-cause healthcare costs were examined. Total all-cause costs included costs from inpatient, outpatient, chemotherapy drug and administration, granulocyte colony-stimulating factor (G-CSF), radiation therapy, and other outpatient and pharmacy costs.

Results: A total of 3115 patients met the criteria for inclusion and received 1L treatment with either FFX, mFFX, or GnP. Among those, 1703 had commercial insurance (FFX, 536; mFFX, 673; GnP, 494) and 1412 had Medicare Advantage (FFX, 201; mFFX, 317; GnP, 894). Total cost of care (mean [SD]) was similar between regimens for each insurance cohort (mean [SD] commercial: FFX, $137 813 [$ 127 504]; mFFX, $120 109 [$ 112 208]; GnP, $133 042 [$ 154 248]; Medicare Advantage: FFX, $110 788 [$ 98 492]; mFFX, $98 667 [$ 83 437]; GnP, $110 211 [$ 100 150]). For both insurance cohorts, chemotherapy drug costs were highest for GnP (mean [SD] commercial: FFX, $10 916 [$ 21 647]; mFFX, $7653 [$ 10 054]; GnP, $60 466 [$ 112 589]; Medicare Advantage: FFX, $8028 [$ 11 044]; mFFX, $6016 [$ 7688]; GnP, $49 263 [$ 49 373]), while chemotherapy administration costs were higher for FFX and mFFX (commercial: FFX, $25 458 [$ 33 350]; mFFX, $22 795 [$ 24 309]; GnP $12 206 [$ 15 766]; Medicare Advantage: FFX, $25 512 [$ 36 352]; mFFX, $21 524 [$ 22 317]; GnP $11 103 [$ 13 089]). G-CSF costs were also higher for FFX and mFFX (commercial: FFX, $38 074 [$ 56 593], mFFX, $27 823 [$ 41 166]; GnP, $4029 [$ 14 181]; Medicare Advantage: FFX, $30 535 [$ 56 630]; mFFX, $24 596 [$ 39 286]; GnP, $2412 [$ 9115]).

Discussion: Total costs of 1L FFX, mFFX, and GnP were similar within a commercially insured and Medicare Advantage cohort. FFX and mFFX costs were largely driven by chemotherapy administration and G-CSF costs, while GnP costs were driven by chemotherapy drug costs.

Conclusions: To fully assess the economic impact of mPDAC in 1L treatment, it is essential to consider both the total cost and the individual cost components, such as chemotherapy drugs, administration, and supportive care costs.

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FOLFIRINOX、改良FOLFIRINOX和吉西他滨联合nab -紫杉醇治疗转移性胰腺导管腺癌的一线治疗成本

背景：需要进一步的研究来确定转移性胰腺导管腺癌（mPDAC）的一线（1L）治疗成本，包括FOLFIRINOX （FFX）、改良的FFX （mFFX）和吉西他滨联合nab-紫杉醇（GnP）。目的：描述医疗保健费用按治疗方案，按商业和医疗保险优势分层。方法：利用Optum的去识别市场清晰度数据集对成年mPDAC患者进行回顾性队列研究。调查了人口统计学、临床特征和1L未调整的全因医疗保健费用。总全因费用包括住院、门诊、化疗药物和给药、粒细胞集落刺激因子（G-CSF）、放射治疗以及其他门诊和药房费用。结果：共有3115例患者符合纳入标准，并接受了FFX、mFFX或GnP的1L治疗。其中，1703人有商业保险（FFX, 536; mFFX, 673; GnP, 494）， 1412人有医疗保险优惠（FFX, 201; mFFX, 317; GnP, 894）。每个保险队列的总医疗成本（平均[SD]）在不同方案之间相似（平均[SD]商业：FFX， 137 813 [127 504]; mFFX, 120 109 [112 208]; GnP, 133 042[154 248]；联邦医疗保险优势：FFX， 110 788 [98 492]; mFFX, 98 667 [83 437]; GnP, 110 211[100 150]）。对于保险组,化疗药物成本最高国民生产总值(意味着(SD)商业:FFX 10 916 [21 647]; mFFX, 7653[054],国民生产总值,60 466(112 589),医疗保险优势:FFX, 8028 [11 044]; mFFX, 6016[7688],国民生产总值,49 263[49 373]),而化疗管理成本更高的FFX和mFFX(商业:FFX, 25 458 [33 350]; mFFX, 22 795[24 309]; 206年国民生产总值12日[15 766];医疗保险优势:FFX, 25 512 [36 352]; mFFX, 21 524 (22 317);GnP 11 103[13 089])。FFX和mFFX的G-CSF成本也较高（商业：FFX， 38 074 [56 593], mFFX, 27 823 [41 166]; GnP, 4029 [14 181]; Medicare Advantage: FFX, 30 535 [56 630]; mFFX, 24 596 [39 286]; GnP, 2412[9115]）。讨论：1L FFX、mFFX和GnP的总成本在商业保险和医疗保险优势队列中是相似的。FFX和mFFX成本主要由化疗给药和G-CSF成本驱动，而GnP成本主要由化疗药物成本驱动。结论：为了充分评估mPDAC在1L治疗中的经济影响，必须考虑总成本和个体成本组成部分，如化疗药物、给药和支持护理成本。

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