title: Pancreatic cancer - cost for overtreatment with gemcitabine.
abstract: Gemcitabine has been the standard chemotherapeutic agent in pancreatic cancer. However, two-thirds of pancreatic tumors display low expression of human equilibrative nucleoside transporter 1 (hENT1), which mediates cellular entry of the drug, and do not respond to gemcitabine therapy. The objective was to determine the costs of gemcitabine overtreatment and the cost-effectiveness of hENT1 testing using a Swedish pancreatic cancer cohort.
  
  
  METHODS
  The study population included 87 patients that were diagnosed with pancreatic cancer during 2008-2010 at Skåne University Hospital, Lund. A detailed review of treatments, side effects and resource utilization was performed. The proportion of hENT1-low was estimated at two-thirds based on previous evaluations of tumor samples from the Radiation Therapy Oncology Group (RTOG) trial 9704, the German AIO Pancreatic Cancer Group (AIO-PK) trial 0104, the Low hENT1 and Adenocarcinoma of the Pancreas (LEAP) trial and the authors' own institution. The cost of the hENT1 test was estimated at €50-200.
  
  
  RESULTS
  Sixty patients received gemcitabine and the other 27 best supportive care. Drug administration and hospitalization were the main expenditures. Grade 3 and 4 toxicities occurred in 42%, the most common being neutropenia (18%). The hospital costs related to gemcitabine overtreatment amounted to €5358 per pancreatic cancer patient, corresponding to as much as one-third of the total treatment cost. The health economical costs amounted to €9449 per patient when including indirect costs. Using hENT1 testing to select patients for gemcitabine therapy would save €8.6 million in Sweden each year.
  
  
  CONCLUSIONS
  Total costs related to gemcitabine overtreatment were high. Individualizing gemcitabine treatment is cost-saving and would reduce unnecessary treatment-related toxicity.
authors.affiliation: Department of Surgery, Clinical Sciences Lund, Skåne University Hospital and Lund University, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansari
authors.forename: Bobby
authors.initials: B
authors.lastname: Tingstedt
authors.forename: Roland
authors.initials: R
authors.lastname: Andersson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D033703:Nucleoside Transport Proteins / Q000032:analysis; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000378:metabolism; D057285:Precision Medicine; D012189:Retrospective Studies; D013548:Sweden; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D033703:Nucleoside Transport Proteins; D003841:Deoxycytidine; D000093542:Gemcitabine