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. 2025 Aug 22;12(2):75-84.
doi: 10.36469/001c.142403. eCollection 2025.

Costs of First-Line Treatment With FOLFIRINOX, Modified FOLFIRINOX, and Gemcitabine With Nab-Paclitaxel in Metastatic Pancreatic Ductal Adenocarcinoma

Syvart Dennen  1 , Marty Masek  1 , Paul Cockrum  2 , Elizabeth Nagelhout  1 , Ravi Paluri  3
Affiliations

Costs of First-Line Treatment With FOLFIRINOX, Modified FOLFIRINOX, and Gemcitabine With Nab-Paclitaxel in Metastatic Pancreatic Ductal Adenocarcinoma

Syvart Dennen et al. J Health Econ Outcomes Res. .

Abstract

Background: Further research is needed to determine real-world costs of first-line (1L) treatment of metastatic pancreatic ductal adenocarcinoma (mPDAC) with FOLFIRINOX (FFX), modified FFX (mFFX), and gemcitabine with nab-paclitaxel (GnP).

Objectives: To describe healthcare costs by treatment regimen, stratified by commercial and Medicare Advantage insurance.

Methods: This retrospective cohort study of adult patients with mPDAC utilized Optum's de-identified Market Clarity Dataset. Demographics, clinical characteristics, and 1L unadjusted all-cause healthcare costs were examined. Total all-cause costs included costs from inpatient, outpatient, chemotherapy drug and administration, granulocyte colony-stimulating factor (G-CSF), radiation therapy, and other outpatient and pharmacy costs.

Results: A total of 3115 patients met the criteria for inclusion and received 1L treatment with either FFX, mFFX, or GnP. Among those, 1703 had commercial insurance (FFX, 536; mFFX, 673; GnP, 494) and 1412 had Medicare Advantage (FFX, 201; mFFX, 317; GnP, 894). Total cost of care (mean [SD]) was similar between regimens for each insurance cohort (mean [SD] commercial: FFX, 137 813 [ 127 504]; mFFX, 120 109 [ 112 208]; GnP, 133 042 [ 154 248]; Medicare Advantage: FFX, 110 788 [ 98 492]; mFFX, 98 667 [ 83 437]; GnP, 110 211 [ 100 150]). For both insurance cohorts, chemotherapy drug costs were highest for GnP (mean [SD] commercial: FFX, 10 916 [ 21 647]; mFFX, 7653 [ 10 054]; GnP, 60 466 [ 112 589]; Medicare Advantage: FFX, 8028 [ 11 044]; mFFX, 6016 [ 7688]; GnP, 49 263 [ 49 373]), while chemotherapy administration costs were higher for FFX and mFFX (commercial: FFX, 25 458 [ 33 350]; mFFX, 22 795 [ 24 309]; GnP 12 206 [ 15 766]; Medicare Advantage: FFX, 25 512 [ 36 352]; mFFX, 21 524 [ 22 317]; GnP 11 103 [ 13 089]). G-CSF costs were also higher for FFX and mFFX (commercial: FFX, 38 074 [ 56 593], mFFX, 27 823 [ 41 166]; GnP, 4029 [ 14 181]; Medicare Advantage: FFX, 30 535 [ 56 630]; mFFX, 24 596 [ 39 286]; GnP, 2412 [ 9115]).

Discussion: Total costs of 1L FFX, mFFX, and GnP were similar within a commercially insured and Medicare Advantage cohort. FFX and mFFX costs were largely driven by chemotherapy administration and G-CSF costs, while GnP costs were driven by chemotherapy drug costs.

Conclusions: To fully assess the economic impact of mPDAC in 1L treatment, it is essential to consider both the total cost and the individual cost components, such as chemotherapy drugs, administration, and supportive care costs.

Keywords: cost drivers; healthcare resource utilization; pancreatic cancer; payer perspectives; real-world evidence; supportive care.

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Conflict of interest statement

S.D., M.M., and E.N. are employees of Genesis Research Group, which received consulting fees from Ipsen Biopharmaceuticals Inc. P.C. reports former employment and equity holder in Ipsen Biopharmaceuticals, Inc. R.P. has received honorarium for consultation and speaking from Ipsen Biopharmaceuticals Inc. and Seagen and for consultation from Exelixis.

Figures

Figure 1.
Figure 1.. Cohort Attrition
Abbreviations: FFX, FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin); GnP, gemcitabine with nab-paclitaxel; mFFX, modified FOLFIRINOX; mPDAC, metastatic pancreatic ductal adenocarcinoma.
Figure 2.
Figure 2.. Total Costs Among Commercial and Medicare Insurance Groups Treated With 1L FFX, mFFX, or GnP
Abbreviations: FFX, FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin); GnP, gemcitabine with nab-paclitaxel; mFFX, modified FOLFIRINOX; USD, US dollars. Compact letter display (CLD) is used to show statistically significant differences. Categories with a letter in common show no evidence of a difference, while categories without a letter in common show a statistically significant difference at ɑ = 05. Full results of the ANOVA and Games-Howell tests are available in Supplementary Table S4.
Figure 3.
Figure 3.. Inpatient Costs Among Commercial and Medicare Insurance Groups Treated With 1L FFX, mFFX, or GnP
Abbreviations: FFX, FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin); GnP, gemcitabine with nab-paclitaxel; mFFX, modified FOLFIRINOX; USD, US dollars. See Figure 2 footnote or the methods section for an explanation of the lettering system for statistically significant differences. Testing is within payer type; Medicare and commercial cost were not calculated for this outcome.
Figure 4.
Figure 4.. Outpatient Costs Among Commercial and Medicare Insurance Groups Treated With 1L FFX, mFFX, or GnP
Abbreviations: FFX, FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin); GnP, gemcitabine with nab-paclitaxel; mFFX, modified FOLFIRINOX; USD, US dollars. See Figure 2 footnote or the methods section for an explanation of the CLD lettering system for statistically significant differences. Testing is within payer type; Medicare and commercial cost were not calculated for these outcomes. A small number of patients were excluded from subcategories where their cost was negative. Due to this, the sum of the subcategories may differ by a small amount from the total outpatient cost for some treatment regimens and insurance types. The other outpatient costs subcategory in this figure includes both other outpatient medical and other outpatient pharmacy, reported separately in the Supplementary Material.
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