title: Cost description of chemotherapy regimens for the treatment of metastatic pancreas cancer.
abstract: Multiple chemotherapy regimens are available for the treatment of metastatic pancreas cancer (mPCA). Choice of regimen is based on the patient's performance status and toxicity profile of the regimen. The objective of this study was to analyze the costs of first-line regimens to further aid in decision-making and develop a platform upon which to assess value. We calculated the monthly cost for individual standard regimens (gemcitabine, gemcitabine/nab-paclitaxel, gemcitabine/erlotinib and FOLFIRINOX) and the overall treatment cost for a course of therapy based on the median progression-free survival achieved in published studies. In addition to cost of drugs, we included administration costs and costs of toxicities (including growth factor support, blood product transfusion and hospitalization for toxicities). Costs for administration and management of adverse events were based on Medicare reimbursement rates for hospital and physician services. Drug costs were based on Medicare average sale prices (all 2014 US$). The monthly costs for gemcitabine, FOLFIRINOX, gemcitabine/erlotinib and gemcitabine/nab-paclitaxel were $1363, $7234, $8007 and $12,221, respectively. The overall treatment costs for a course of the same regimens based on median PFS were $5043, $46,298, $51,004 and $67,216, respectively. The choice of chemotherapy regimen for mPCA should be based on tolerability and efficacy of the regimen individualized to patient's performance status. Healthcare systems have finite resources; thus, there is increasing emphasis on metrics to define value in health care when outcomes of therapy are similar or produce marked differences in value. These data provide useful financial information to incorporate into the decision-making process.
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.|Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Goldstein
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, A445 Starling Loving Hall, 320 W 10th Avenue, Columbus, OH, 43210, USA.
authors.forename: Kavya
authors.initials: K
authors.lastname: Krishna
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Bassel F
authors.initials: BF
authors.lastname: El-Rayes
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, A445 Starling Loving Hall, 320 W 10th Avenue, Columbus, OH, 43210, USA.
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, A445 Starling Loving Hall, 320 W 10th Avenue, Columbus, OH, 43210, USA. anne.noonan@osumc.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Noonan
mesh_terms: D000418:Albumins / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D006801:Humans; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D003841:Deoxycytidine; D017239:Paclitaxel; D000093542:Gemcitabine
keywords: Chemotherapy costs; First-line regimens; Metastatic pancreas cancer; Toxicity costs; Value