Population-based economic impact of nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer.

16 Background: Increasingly, assessing the quality of cancer treatment involves scrutiny of both outcomes and economics, particularly for advances in areas where generic agents have been standards of care. With nab-paclitaxel plus gemcitabine (nab-P/G) demonstrating a significantly improved updated median overall survival in first-line metastatic pancreatic cancer (1mPanc) patients (pts) vs gemcitabine (G) monotherapy (8.7 vs 6.6 months), this analysis aims to estimate the economic impact for a US health plan population, from adding nab-P/G as a treatment option for this condition.A three-year budget impact model was constructed to estimate 1mPanc costs for nab-P/G, G, gemcitabine + erlotinib (EG), other G combinations (OG), and FOLFIRINOX (F), from a US health plan perspective in 2013 US dollars. Inputs for prevalence, drug, administration, G-CSF, and adverse events were derived from SEER, prescribing information, publications, 3Q2014 Medicare reimbursement rates, and other public sources. The model used 2013 patient treatment mix rates as reported by Cartwright et al (ASCO 2013) with nab-P/G growing to 25% by 2015.A population mirroring the US age mix would have 7 pts with 1mPanc annually per 100,000 lives. Treatment mix for 2013 was 27% F, 8% nab-P/G, 51% G, 8% EG, and 6% OG. Total costs per course of therapy per patient (pt) are shown in table. Baseline (before nab-P/G) population costs per 100,000 lives were $111,400 ($15,914 per average pt). Adding nab-P/G to the treatment mix for 1mPanc added $6,083 to population costs ($869 per average pt) for 2013, rising to $20,117 ($2,874 per average pt) for 2015 vs the baseline.Adding nab-paclitaxel plus gemcitabine as a treatment option for first-line metastatic pancreatic cancer pts was estimated to increase costs by 12% (about $2000 per average pt per year) over a three year period. The principal cost drivers were replacement of generic gemcitabine monotherapy, partially offset by savings from replacing FOLFIRINOX. [Table: see text].