In MPC, Gemcitabine/Nab-Paclitaxel More Cost Effective Than With FOLFIRINOX

Ali McBride, PharmD

Real-world data presented at the 2017 Gastrointestinal Cancers Symposium demonstrated that significantly higher costs were associated with FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, oxaliplatin) as frontline therapy compared with the combination of nab-paclitaxel and gemcitabine in patients with metastatic pancreatic cancer (MPC).

The study of an insured US population with MPC demonstrated higher costs associated with treatment administration and use of granulocyte colony stimulating factor (GCSF), filgrastim, and peg-filgrastim in patients who initiated treatment with FOLFIRINOX, according to the investigation led by Ali McBride, PharmD, from the University of Arizona Cancer Center, Tucson.

“Results from this claims analysis suggest that MPC patients who initiated nab-paclitaxel plus gemcitabine had similar treatment duration but lower total all-cause costs than those with FOLFIRINOX, although this difference was not statistically significant,” according to the poster presentation. “The lower total costs for the nab-paclitaxel plus gemcitabine cohort were driven by the lower costs of treatment administration and supportive care.”

The investigators used US administrative claims data from the Truven Health MarketScan Commercial and Medicare Supplemental Databases to compare healthcare costs and treatment patterns in patients with MPC who initiated treatment with one of the 2 regimens. This database includes pharmacy data for enrollees who number roughly 41 million each year. Patients who completed at least 1 cycle of the index regimen were included in the analysis. Eligible patients were those who were continuously enrolled in the database with medical and pharmacy benefits for ≥6 months prior and ≥3 months following the index date.

Total healthcare costs and MPC-related treatment costs were measured per patient, per month (PPPM) during their index regimen. A total of 550 MPC patients met the inclusion criteria; of those, 294 initiated nab-paclitaxel plus gemcitabine and 256 initiated FOLFIRINOX. Patients on nab-paclitaxel plus gemcitabine were significantly older (mean age: 63.6 vs 58.8 years; P <.001) and had more unique diagnostic categories (21.2 vs 19.0; P <.001) versus FOLFIRINOX. Compared with nab-paclitaxel/gemcitabine, recipients of FOLFIRINOX were more likely to have commercial insurance (56.1% vs 79.3%; P <.01) and less likely to be on Medicare (43.9% vs 20.7%; P <.01).

A lower percentage of patients who started on nab-paclitaxel and gemcitabine discontinued treatment compared with FOLFIRINOX (60.9% vs 70.3%; P = .02). The median duration of treatment was not significantly different between the 2 cohorts: 5 months for nab-paclitaxel plus gemcitabine versus 5.2 months for FOLFIRINOX (P = .60), which remained consistent when adjusting for baseline characteristics (HR, 0.91; 95% CI, 0.724-1.132).

Total average healthcare costs were $23,604 for MPC patients initiating treatment with nab-paclitaxel plus gemcitabine versus $26,575 for those initiating FOLFIRINOX (P = 0.082). Pharmacy costs were significantly lower for the nab-paclitaxel plus gemcitabine cohort compared with the FOLFIRINOX cohort (P <.01) but medical costs were similar during the line of therapy. After adjusting for differences in baseline characteristics, investigators found that the nab-paclitaxel plus gemcitabine regimen corresponded with significantly lower pharmacy costs compared with the FOLFIRINOX regimen ($722 vs $1,343; P <.01), but medical costs between the 2 groups were not significantly different ($22,939 vs $22,987; P = .97).

Both unadjusted ($2,966 vs $8,758; P <.01) and adjusted ($2,708 vs $7,428; P <.01) supportive care costs during therapy were significantly lower for nab-paclitaxel plus gemcitabine compared with FOLFIRINOX. This difference was driven primarily by lower costs of GCSF, antiemetics, hydration treatments, antithrombotics, and other infusions in patients initiating nab-paclitaxel plus gemcitabine compared with FOLFIRINOX.

Compared with FOLFIRINOX, patients initiating nab-paclitaxel plus gemcitabine incurred lower treatment administration costs ($2,969 vs $1,859; P <.01) but higher chemotherapy costs ($6,384 vs $12,103; P < .01).

McBride A, Bonafede M, Cai Q, et al. Health care costs and treatment patterns among metastatic pancreatic cancer (MPC) patients (pts) initiating first-line (1L) on nab-paclitaxel/gemcitabine (nab-P+G) or FOLFIRINOX (FFX). Presented at: 2017 Gastrointestinal Cancers Symposium; January 19-21, 2017; San Francisco, CA. Abstract 415.