Comparing total cost of care for Medicare FFS patients with pancreatic cancer by chemotherapy regimen.

Abstract

721 Background: To analyze total cost of care for patients with pancreatic cancer by FDA-Approved/NCCN Category 1 regimen. Methods: Cancer episodes were identified using a methodology similar to the Medicare Oncology Care Model (OCM) in the 2014-2016 100% Medicare Limited Data Set (LDS) claims files. Index dates were established for chemotherapy claims that did not occur within 6 months of another chemotherapy claim for all Medicare fee-for-service beneficiaries. Cancer episodes were defined as the 6-month period following an index date. Each episode was assigned a cancer type based on the plurality of cancer ICD 9/10 diagnosis codes that occurred on chemotherapy claims in the episode. Episode costs were calculated from claim paid amounts, and DME and other Part B spending was estimated using episodes created in the 5% Medicare LDS files using the same methodology. We analyzed total episode costs for three FDA-Approved/NCCN Category 1 pancreatic cancer regimens: gemcitabine plus nab-paclitaxel (gem-nab), FOLFIRINOX (FFX), and liposomal irinotecan (nal-IRI). Results: We identified 110,618 cancer episodes in 2016, of which 4,018 were for pancreatic cancer (average age at index: 71.3 years). Pancreatic cancer patients in these episodes were treated with gem-nab (45% of episodes), FFX (14%), and nal-IRI (4%). The main cost drivers across all regimens were Part B chemotherapy, other Part B drugs and inpatient services. Episode costs were $41,749, $42,086, and $45,851 for patients receiving gem-nab, FFX, and nal-IRI, respectively. Part B chemotherapy costs were $13,065 (gem-nab), $3,095 (FFX), and $18,472 (nal-IRI); other Part B drug costs were $7,343 (gem-nab), $17,013 (FFX), and $10,479 (nal-IRI); and inpatient service costs were $9,044 (gem-nab), $9,069 (FFX), and $5,108 (nal-IRI). Conclusions: Total episode costs for pancreatic cancer care were similar among three FDA-Approved/NCCN Category 1 regimens, but the components of cost varied. Episodes with Nal-IRI had the largest Part B chemotherapy costs and the lowest inpatient service costs. Episodes with FFX and gem-nab had similar inpatient service costs, which were higher than episodes with nal-IRI. Episodes with FFX had the highest other Part B drug costs.