Costs of Treatment-Related Adverse Events in Pancreatic Cancer

Researchers assessed adverse event (AE)-related costs associated with U.S. Food and Drug Administration approved/National Comprehensive Cancer Network Category 1 treatments for pancreatic cancer among Medicare fee-for-service beneficiaries and found that AEs impose substantial costs for these patients. The results of the study were presented by Jared Hirsch, BS, actuarial analyst at Milliman Inc., at HOPA’s 16th Annual Conference.

Researchers used Medicare claims files from 2013 to 2017, containing all Medicare fee-for-service Part A and B claims, except professional services and durable medical equipment, for 45 million beneficiaries. Line of therapy was determined based on the order of therapies used, with first line of therapy defined as the first episode of an eligible therapy given after or in the 14 days preceding the beneficiary’s earliest metastasis diagnosis date (index).

The therapies studied were gemcitabine/nab-paclitaxel, gemcitabine monotherapy, FOLFIRINOX (folinic acid, fluorouracil, irinotecan, and oxaliplatin), and liposomal irinotecan (this was most commonly used in second-line setting). The 30-day costs were calculated starting on the day of AE onset or shadow AE date.

The study included a total of 9,185 patients who received any chemotherapy regimen of interest (average age, 71.6 years) and 22,241 controls who did not receive these regimens (average age, 74.2 years).

The most common AE was anemia—ranging from 32% to 41% based on treatment regimen. Neutropenia was another common AE that occurred in 16% to 32% of patients, as well as thrombocytopenia that occurred in 12% to 18% of patients.

Mean 30-day incremental anemia-related costs ranged from $3,257 to $3,924, while costs for neutropenia ranged from $1,284 and $2,503, and costs for thrombocytopenia ranged from $2,678 to $3,721. For the first-line regimens, anemia, neutropenia, and thrombocytopenia were statistically significantly associated with incremental costs. With second-line liposomal irinotecan, only anemia was statistically significantly associated with incremental costs.


Hirsch J, Dieguez G, Cockrun P. The cost of adverse events for FDA-approved/NCCN® category 1 treatmetns for Medicare fee-for-service patients with metastatic pancreatic cancer. Presented at HOPA 16th Annual Conference. March 11-14, 2020, Tampa, Florida.