TOTAL Cost of Care and Utilization Among Medicare Fee-for-Service (FFS) Patients with Metastatic Pancreatic Cancer Treated with FDA-Approved/NCCN® Category 1 Regimens at 340B VS. NON-340B Hospitals
Author(s)
Tomicki S1, Latimer H2, Dieguez G2, Cockrum P3, Kim GP4
1Milliman, Inc., Bellingham, WA, USA, 2Milliman, Inc., New York, NY, USA, 3Ipsen, Cambridge, MA, USA, 4George Washington University, Washington, DC, USA
Presentation Documents
OBJECTIVES: To compare total cost of care (TCOC) and utilization for Medicare FFS patients (pts) with metastatic pancreatic cancer (m-PANC) treated at 340B or non-340B hospitals, by NCCN® Category 1 regimen. METHODS: We identified pts with m-PANC using ICD-9/10 diagnosis codes in the 2016-18 Medicare Parts A/B/D 100% Research Identifiable Files. Study pts had 2+ claims with a pancreatic cancer diagnosis and Medicare FFS coverage for 6 months pre- and 3 months post-metastasis diagnosis. 340B hospitals were identified using the 340B OPAIS database. Pts were attributed to 340B or non-340B hospitals based on plurality of chemotherapy claims. Mean TCOC includes all insurer-paid services per line of therapy (excluding patient cost share). We calculated mean rates of hospital admissions (admits/pt) and readmissions. Study pts were treated with NCCN® Category 1 regimens: 1L gemcitabine monotherapy (gem-mono), 1L gemcitabine/nab-paclitaxel (gem-nab), 1L FOLFIRINOX (FFX), and 2L liposomal irinotecan-based regimen (Nal-IRI). RESULTS: We identified 5,098 (340B) and 7,450 (non-340B) pts. Across regimens, TCOC was higher at non-340B ($21,144-$53,127) than at 340B hospitals ($18,544-$44,947). There were no consistent differences in admits/pt and readmission rate between cohorts. Gem-mono had the lowest TCOC (340B: $18,544, P<.05; non-340B: $21,144, P<.05) in both cohorts, while Nal-IRI had the highest (340B: $44,947, P>.05, non-340B: $53,127, P<.05); Nal-IRI pts also had the lowest admits/pt (340B: 0.72, P>.05; non-340B: 0.72, P>.05), while gem-nab had the highest (340B: 1.19, P>.05; non-340B: 1.18, P>.05). Gem-mono and Nal-IRI had the lowest readmission rate at 340B (7%, P>.05) and non-340B (9%, P>.05). CONCLUSIONS: While TCOC at 340B hospitals was 2%-15% lower than at non-340B hospitals overall, there was no consistent pattern of admits/pt and readmission rates. Among regimens, there were consistencies in both cohorts: TCOC was lowest for gem-mono and highest for Nal-IRI, while admits/pt were lowest for 2L Nal-IRI and highest for gem-nab.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Code
PDB17
Topic
Economic Evaluation, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Health & Insurance Records Systems, Pricing Policy & Schemes
Disease
Diabetes/Endocrine/Metabolic Disorders