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THE COST-EFFECTIVENESS OF TREATMENT MODALITIES IN RESECTABLE PANCREATIC CANCER: A VALUE-BASED ANALYSIS
Benjamin Varughese
*1, Isabel Lavine
1, Sophia Shah
1, Harish Lavu
2, Wilbur Bowne
2, Charles Yeo
2, Avinoam Nevler
21Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; 2Department of Surgery, Thomas Jefferson University, Philadelphia, PA
Background: Pancreatic ductal adenocarcinoma (PDAC) ranks as the third leading cause of cancer-related mortality in the United States. The cost-effectiveness of surgery compared to other treatments, such as chemotherapy and radiotherapy, is not well understood. This study aims to identify relationships between patient survival, therapeutic regimens, and the cost of care from a national cohort of patients with PDAC.
Methods: This study analyzed early-stage resectable PDAC treatment in 4489 patients between 2016 and 2021 using the SEER database. Patients with AJCC Stage I-IIB and T1-3 tumors were included. Treatment regimens and survival outcomes post-diagnosis were recorded. A Cox regression of age, TNM staging, and treatments was used to analyze survival outcomes. Median survival was calculated for each treatment scenario (i.e. surgery ± chemotherapy ± radiotherapy) and cross-referenced with previously published costs of cancer treatments to yield an estimation of the "survival cost" ($cost/month of survival from diagnosis). Costs of therapies were extracted from published data and compared with recent real-world costs from a high-volume pancreatic surgery center. Perioperative chemotherapy costs were calculated for a standard of 12 cycles of FOLFIRINOX or 7 cycles of gemcitabine/nab-paclitaxel.
Results: The mean age was 66±8.1 years, with 48% female patients. Therapy groups that included surgery had the highest median survival. Notably, the patients who received chemotherapy, radiation, and surgery (n=253, 5.6%) had the highest estimated median survival (22.0±1.1 months). Patients who underwent chemotherapy only (n=994, 22.1%) had the lowest median survival (13.0±0.3 months). Surgery and chemotherapy were found to be strong prognostic indicators for overall survival (HR=0.2, HR=1.1, P<0.001, and P=0.036, respectively). For example, T2N1 patients who received surgery, chemotherapy, and radiation had an estimated median survival of 49 months while chemotherapy only patients had a median survival of 7 months (Figure 1). Additionally, surgery had the lowest "survival cost", wherein every $580 of cost resulted in one added month of survival compared to chemotherapy alone, which ranged from $14,070 (FOLFIRINOX) to $38,588 (Gemcitabine/nab-Paclitaxel) per month of survival in a T2N1 staged patient (Figure 2).
Conclusion: These results underscore the value of surgery as a core therapy for pancreatic cancer and showcase the financial implications of surgical intervention in early-stage pancreatic cancer patients. With the increase in costs of medical care, it is important to assess and evaluate the development of treatment plans from a cost-effective perspective. Our data suggests that investments in improving patients’ access to surgery and development of high-quality pancreatic surgery programs may offer a favorable result from a value-based viewpoint.
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