OBJECTIVES: To compare total cost of care (TCOC) and utilization for Medicare FFS patients (pts) with metastatic pancreatic cancer (m-PANC) treated at teaching or non-teaching 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. Teaching hospitals were identified using CMS Fiscal Year IPPS Final Rule and Correction Notices. Pts were attributed to teaching or non-teaching hospitals based on plurality of chemotherapy claims. TCOC was the sum of mean paid services by the insurer per line of therapy. 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 7,594 and 4,959 pts in teaching and non-teaching cohorts, respectively. There were no significant differences in TCOC, admits/pt, or readmissions between teaching and non-teaching hospitals. In both cohorts, gem-mono had the lowest TCOC (teaching: $19,476, P<.05; non-teaching: $22,298, P<.05), while Nal-IRI had the highest (teaching: $49,776, P<.05;, non-teaching: $48,191, P>.05). In both cohorts, Nal-IRI had the lowest admits/pt (teaching: 0.69, P<.05; non-teaching: 0.77 P>.05) and readmissions (teaching: 12%, P>.05; non-teaching: 13%, P>.05) while gem-nab had the highest admits/pt (teaching: 1.21, P>.05; non-teaching: 1.15, P>.05) and readmissions (teaching: 19%, P>.05; non-teaching: 17%, P>.05).

CONCLUSIONS: Despite teaching hospitals receiving add-on payments, there were no consistent differences in TCOC between teaching and non-teaching hospitals. Additionally, admits/pt and readmissions by regimen were similar among cohorts. However, across cohorts TCOC was lowest for gem-mono and highest for Nal-IRI and admits/pt and readmissions were lowest for Nal-IRI and highest for gem-nab.