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

Abstract

e19394 Background: To analyze total cost of care for patients with pancreatic cancer by common therapeutic regimens. 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 for chemotherapy claims could not occur within 6 months of another chemotherapy claim for all Medicare FFS 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 claims paid amounts. DME and other Part B spending was estimated using episodes from the 5% Medicare LDS files using the same methodology. We analyzed total episode costs for five pancreatic cancer treatment regimens: gemcitabine plus nab-paclitaxel (gem-nab), FOLFIRINOX, liposomal irinotecan, FOLFOX, and FOLFIRI. Results: We identified 110,618 cancer episodes in 2016, of which 4,018 were pancreatic cancer. Pancreatic cancer patients in these episodes were treated with gem-nab (45% of episodes), FOLFIRINOX (14%), FOLFOX (8%), FOLFIRI (6%), and liposomal irinotecan (4%). The main drivers of episode costs among regimens were Part B chemotherapy, other Part B drugs, and inpatient services. Episode costs were $41,749, $42,086, $35,601, $36,169, and $45,851 for patients receiving gem-nab, FOLFIRINOX, FOLFOX, FOLFIRI, and liposomal irinotecan, respectively. Part B chemotherapy costs were $13,065 (gem-nab), $3,095 (FOLFIRINOX), $4,853 (FOLFOX), $3,204 (FOLFIRI), and $18,474 (liposomal irinotecan); other Part B drug costs were $7,343 (gem-nab), $17,013 (FOLFIRINOX), $11,131 (FOLFOX), $15,377 (FOLFIRI), and $10,479 (liposomal irinotecan); and inpatient service costs were $9,044 (gem-nab), $9,069 (FOLFIRINOX), $7,701 (FOLFOX), $5,838 (FOLFIRI), and $5,108 (liposomal irinotecan). Conclusions: Total episode costs for pancreatic cancer care ranged from $35,601 (FOLFOX) to $45,851 (liposomal irinotecan), but the cost components varied by regimen. Episodes with liposomal irinotecan had the largest Part B chemotherapy costs but the lowest inpatient service costs. Episodes with FOLFIRINOX and gem-nab had similar inpatient service costs, which were higher than episodes with liposomal irinotecan, FOLFOX, or FOLFIRI. Episodes with FOLFIRINOX and FOLFIRI had higher other Part B drug costs than episodes with FOLFOX, liposomal irinotecan, or gem-nab.