Bhatt Prachi, Hirsch Jared, Cockrum Paul, Kim George, Dieguez Gabriela
Milliman (United States).
Ipsen (United States).
J Health Econ Outcomes Res. 2024 Dec 18;11(2):161-167. doi: 10.36469/001c.124367. eCollection 2024.
Rising oncology healthcare costs have led to value-based care reimbursement models that coordinate care and improve quality while reducing overall spending. These models are increasingly important for traditional Medicare and other payers. To compare the incidence of adverse events (AEs), AE-associated excess costs, and total cost of care (TCOC) of 3 cohorts receiving first-line treatment for metastatic pancreatic ductal adenocarcinoma (mPDAC). We conducted a retrospective analysis of administrative claims data from 2018 to 2022 using the Medicare 100% Research Identifiable Files. We examined 3 cohorts receiving mPDAC treatment: FOLFIRINOX (FFX) (oxaliplatin, irinotecan, leucovorin, 5-FU bolus and infusion); modified FFX, (5-FU infusion only); and gemcitabine/nab-paclitaxel (gem/abrax). We compared the incidence of clinically significant AEs, TCOC, components of TCOC, and costs related to AEs/treatment toxicity. Patient AE rates ranged from 6.2% to 51.7%. AEs occurred more frequently in patients receiving FFX with all 4 components. Patients receiving brand name gem/abrax had lower rates of febrile neutropenia (6.2%) and neutropenia (22.2%) than those receiving FFX with no 5-FU bolus (febrile neutropenia, 9.9%; neutropenia, 36.9%) and FFX with all 4 components (febrile neutropenia, 6.9%; neutropenia, 30.4%). Rates of most nonhematologic AEs were higher in patients receiving FFX with all 4 components, with diarrhea occurring in 28.3%, abdominal pain in 31.5%, and nausea/vomiting in 41.5% of patients. TCOC was lower in the gem/abrax cohort: 6995) and FFX with all 4 components ( 5993 per administration, while the development of any studied nonhematological AE was associated with a mean per-administration excess cost of $3665. Treatment decisions intended to minimize chemotherapy costs may lead to suboptimal decisions if the goal is to reduce TCOC. Our research suggests FFX is more costly than gem/abrax (TCOC per administration). Patients receiving gem/abrax were older and had higher baseline Charlson Comorbidity Index scores; however, other factors may be important in driving cost differences. Irrespective of drug cost, chemotherapy leading to a significant increase in AEs is associated with higher TCOC.
肿瘤医疗成本的不断上升促使了基于价值的医疗报销模式的出现，这种模式在协调医疗服务、提高质量的同时降低了总体支出。这些模式对传统医疗保险和其他支付方来说日益重要。为了比较接受转移性胰腺导管腺癌（mPDAC）一线治疗的3个队列的不良事件（AE）发生率、与AE相关的额外成本以及总护理成本（TCOC）。我们使用医疗保险100%可识别研究文件对2018年至2022年的行政索赔数据进行了回顾性分析。我们研究了3个接受mPDAC治疗的队列：FOLFIRINOX（FFX）（奥沙利铂、伊立替康、亚叶酸钙、5-氟尿嘧啶推注和输注）；改良FFX（仅5-氟尿嘧啶输注）；以及吉西他滨/纳米白蛋白结合型紫杉醇（吉西他滨/白蛋白结合型紫杉醇）。我们比较了具有临床意义的AE发生率、TCOC、TCOC的组成部分以及与AE/治疗毒性相关的成本。患者的AE发生率在6.2%至51.7%之间。在接受包含所有4种成分的FFX治疗的患者中，AE发生得更为频繁。接受品牌吉西他滨/白蛋白结合型紫杉醇治疗的患者发热性中性粒细胞减少症（6.2%）和中性粒细胞减少症（22.2%）的发生率低于未接受5-氟尿嘧啶推注的FFX治疗患者（发热性中性粒细胞减少症，9.9%；中性粒细胞减少症，36.9%）以及接受包含所有4种成分的FFX治疗患者（发热性中性粒细胞减少症，6.9%；中性粒细胞减少症，30.4%）。接受包含所有4种成分的FFX治疗的患者中，大多数非血液学AE的发生率更高，腹泻发生率为28.3%，腹痛发生率为31.5%，恶心/呕吐发生率为41.5%。吉西他滨/白蛋白结合型紫杉醇队列的TCOC较低：每次给药6995美元，而接受包含所有4种成分的FFX治疗的患者为5993美元，而任何研究的非血液学AE的发生与每次给药平均额外成本3665美元相关。如果目标是降低TCOC，旨在最小化化疗成本的治疗决策可能会导致次优决策。我们的研究表明FFX比吉西他滨/白蛋白结合型紫杉醇成本更高（每次给药的TCOC）。接受吉西他滨/白蛋白结合型紫杉醇治疗的患者年龄更大，基线查尔森合并症指数得分更高；然而，其他因素可能在推动成本差异方面也很重要。无论药物成本如何，导致AE显著增加的化疗与更高的TCOC相关。
