title: Comparison of treatment patterns, resource utilization, and cost of care in patients with metastatic pancreatic cancer treated with first-line nab-paclitaxel plus gemcitabine or FOLFIRINOX.
abstract: BACKGROUND
  We compared real-world treatment patterns, resource utilization, and cost of care for patients with metastatic pancreatic cancer treated with first-line nab-paclitaxel + gemcitabine or FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, oxaliplatin).
  
  
  METHODS
  This was a retrospective study of inpatient and hospital-based outpatient data in the United States. Primary endpoints included median time to treatment discontinuation (TTD) and total cost of care per patient per month. Secondary endpoints included supportive care costs and hospitalization rate and length.
  
  
  RESULTS
  Overall, 345 patients were included (nab-paclitaxel + gemcitabine, n = 182; FOLFIRINOX, n = 163). Median TTD was significantly longer with nab-paclitaxel + gemcitabine vs FOLFIRINOX (4.3 vs 2.8 months; P = .0009). Mean acquisition cost was higher with nab-paclitaxel + gemcitabine ($10,643 vs $6549; P = .0043), but mean total cost of care was lower ($16,628 vs $19,936; P = .1740). Supportive care cost was significantly lower with nab-paclitaxel + gemcitabine ($1995 vs $6456; P < .0001). Hospitalization rate and length were both significantly lower with nab-paclitaxel + gemcitabine.
  
  
  CONCLUSIONS
  Despite higher acquisition costs with nab-paclitaxel + gemcitabine, FOLFIRINOX-treated patients had higher total costs driven by supportive care. Toxicity-related costs and drug acquisition costs should be considered when evaluating total cost of care.
authors.affiliation: a 21st Century Oncology LLC , Jacksonville , FL , USA.
authors.forename: George P
authors.initials: GP
authors.lastname: Kim
authors.affiliation: b Celgene Corporation , Summit , NJ , USA.
authors.forename: Monika F
authors.initials: MF
authors.lastname: Parisi
authors.affiliation: b Celgene Corporation , Summit , NJ , USA.
authors.forename: Manish B
authors.initials: MB
authors.lastname: Patel
authors.affiliation: b Celgene Corporation , Summit , NJ , USA.
authors.forename: Corey L
authors.initials: CL
authors.lastname: Pelletier
authors.affiliation: c MedAssets , Mooresville , NC , USA.
authors.forename: Kathy W
authors.initials: KW
authors.lastname: Belk
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002166:Camptothecin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000191:economics; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D002955:Leucovorin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017239:Paclitaxel / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D009944:Organoplatinum Compounds; D003841:Deoxycytidine; D017239:Paclitaxel; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin; D000093542:Gemcitabine
keywords: FOLFIRINOX; gemcitabine; healthcare costs; healthcare utilization; metastatic pancreatic cancer; nab-paclitaxel