PCN302 COMPARING SERVICE UTILIZATION AND COSTS FOR MEDICARE FFS PATIENTS WITH METASTATIC PANCREATIC CANCER BY CHEMOTHERAPY REGIMEN AND LINE OF THERAPY

Abstract

To analyze treatment patterns, costs, and survival rate for patients with metastatic pancreatic cancer (m-PANC) by line of therapy (LOT). We identified patients with m-PANC using ICD-9/10 diagnosis codes in the 2013-2017 Medicare 100% Limited Data Set claims, which include all Medicare paid fee-for-service (FFS) claims, except professional services, for 45 million Medicare FFS beneficiaries. We studied treatment patterns, costs, and survival rate by LOT. Patients in our study had two or more claims with a pancreatic cancer (PANC) diagnosis more than 30 days apart and one or more claims with a secondary malignancy (metastasis) diagnosis on or after the first PANC diagnosis date. We defined index date as the earliest metastasis diagnosis date. We excluded patients with pre-index non-PANC malignancies and those without six months pre-index and three months post-index (or until death) Medicare FFS enrollment. LOTs were assigned based on therapies used. LOTs ended the day before a new chemotherapy began, 28 days after the last chemotherapy (if no new chemotherapy), or upon death. We identified 31,426 m-PANC patients (average age at index: 73.5 years; average Charlson comorbidity index score: 2.8); 10,874 patients (35%) received first line (1L) chemotherapy, 3,197 (10%) received a second line (2L), and 885 (3%) received a third line (3L). Across LOTs, common regimens included gemcitabine/nab-paclitaxel (38% of patients), gemcitabine monotherapy (21%), FOLFIRINOX (11%), FOLFOX (6%), and liposomal irinotecan (3%). Average LOT duration decreased from 150 days in 1L to 108 days in 3L. Average LOT cost varied by regimen from under $15,000 to more than $30,000. The 90-day survival rate decreased from 79% in 1L to 73% in 3L. 35% of Medicare FFS m-PANC patients received chemotherapy, of which the majority received gemcitabine-based therapy. Average LOT costs varied by regimen. LOT duration and 90-day survival rate decreased by LOT.