title: Assessing the Financial Burden Associated With Treatment Options for Resectable Pancreatic Cancer.
abstract: The aim of this study is to assess the financial burden associated with treatment options for resectable pancreatic cancer.
  
  
  
  As the volume of cancer care increases in the United States, there is growing interest among both clinicians and policy-makers to reduce its financial impact on the healthcare system. However, costs relative to the survival benefit for differing treatment modalities used in practice have not been described.
  
  
  
  Patients undergoing resection for pancreatic cancer were identified in the Truven Health MarketScan database. Associations between chemoradiation therapies and survival were performed using parameterized multivariable accelerated failure time models. Median payments over time were calculated for surgery, chemoradiation, and subsequent hospitalizations.
  
  
  
  A total of 2408 patients were included. Median survival among all patients was 21.1 months [95% confidence interval (CI): 19.8-22.5 months], whereas median follow-up time was 25.1 months (95% CI: 23.5-26.5 months). After controlling for comorbidity, receipt of neoadjuvant therapy, and nodal involvement, a longer survival was associated with undergoing combination gemcitabine and nab-paclitaxel [time ratio (TR) = 1.26, 95% CI: 1.02-1.57, P = 0.035) or capecitabine and radiation (TR = 1.25, 95% CI: 1.04-1.51, P = 0.018). However, median cumulative payments for gemcitabine with nab-paclitaxel were highest overall [median $74,051, interquartile range (IQR): $38,929-$133,603).
  
  
  
  Total payments for an episode of care relative to improvement in survival vary significantly by treatment modality. These data can be used to inform management decisions about pursuing further care for pancreatic cancer. Future investigations should seek to refine estimates of the cost-effectiveness of different treatments.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Marcelo
authors: M
authors: Cerullo
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Faiz
authors: F
authors: Gani
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Sophia Y
authors: SY
authors: Chen
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Joseph K
authors: JK
authors: Canner
authors: Department of Radiation Oncology and Medical Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Joseph M
authors: JM
authors: Herman
authors: Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Daniel
authors: D
authors: Laheru
authors: Department of Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH.
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics*; D059248:Chemoradiotherapy / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000191:economics*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D015996:Survival Rate; D014481:United States
chemical_list: D000970:Antineoplastic Agents