Healthcare costs, treatment patterns, and resource utilization among pancreatic cancer patients in a managed care population

Figures & data

Table 1. Population demographics.

	Cancer population (n = 5262)	Control population (n = 15,786)	p-Value
Age (mean years, SD)	66 (12)	65 (12)	0.205
Gender (n, %)
Male	2682 (51)	8046 (51)	1.000
Female	2580 (49)	7740 (49)	1.000
Coverage type (n, %)
Commercial	3700 (70)	11,100 (70)	1.000
Medicare	1562 (30)	4686 (30)	1.000
Geographic region (n, %)
Northeast	626 (12)	1878 (12)	1.000
Midwest	1846 (35)	5538 (35)	1.000
South	2244 (43)	6732 (43)	1.000
West	546 (11)	1638 (11)	1.000
Baseline Quan-Charlson comorbidity index (mean, SD)	1.50 (1.58)	1.48 (1.59)	0.265
Length of total follow-up (mean days, SD)	347 (443)	608 (588)	<0.001
Mortality (n, %)	3239 (62)	1295 (8)	<0.001

Table 2. All-cause healthcare resource use during follow-up. Cancer population vs control population.

	Cancer population (n = 5262)	Control population (n = 15,786)	p-Value
Office visits
n	4645	14,789
%	88	94*	<0.001
Rate^a	30.1*	10.9	<0.001
Outpatient visits
n	4639	10,077
%	88*	64	<0.001
Rate^a	23.5*	3.4	<0.001
ER visits
n	3387	5415
%	64*	34	<0.001
Rate^a	2.0*	0.8	<0.001
Inpatient stays
n	4447	2429
%	85*	15	<0.001
Rate^a	2.1*	0.2	<0.001
Length^b	25*	18	<0.001

^aEvents/person-year (compared using the exact binomial test).

^bMean length of all inpatient stays in days (compared using 2-sided t-test).

Significantly higher results signified by *.

Table 3. All-cause healthcare costs (PPPM) during follow-up. Cancer population vs control population.

Costs ($)	Cancer population (n = 5262)	Control population (n = 15,786)	p-Value
Total costs, mean (SD), median	15,480* (23,176), 9440	1001 (5591), 359	<0.001
Office costs, mean (SD), median	1520* (2500), 319	130 (472), 62	<0.001
Hospital outpatient costs, mean (SD), median	2796* (5468), 813	193 (2100), 14	<0.001
Emergency room costs, mean (SD), median	164* (512), 19	35 (576), 0	<0.001
Inpatient costs, mean (SD), median	9917* (22,069), 3060	344 (4914), 0	<0.001
Other costs, mean (SD), median	393* (1727), 68	101 (540), 7	<0.001
Pharmacy costs, mean (SD), median	689* (1129), 294	197 (312), 104	<0.001

Significantly higher results signified by*.

Table 4. Select treatment/procedure healthcare costs (PPPM) of pancreatic cancer patients during follow-up.

	Total follow-up (n = 5262)	Initial phase (non-metastatic disease) (n = 2651)	Metastatic phase (n = 3227)	p-Value^c
Pancreatic cancer surgery
n (%)^a	1330 (25)	826 (31)	480 (15)
Mean $ (SD)^b	1419 (8166)	1871* (6306)	1435 (9871)	0.041
Radiation therapy
n (%)	1464 (28)	712 (27)	695 (22)
Mean $ (SD)	699 (2423)	1059* (3173)	593 (2429)	<0.001
Chemotherapy
n (%)	2496 (47)	1091 (41)	1535 (48)
Mean $ (SD)	877 (1583)	622 (1409)	1024* (1740)	<0.001
Targeted therapy
n (%)	669 (13)	94 (4)	496 (15)
Mean $ (SD)	172 (647)	86 (622)	228* (732)	<0.001
Laboratory/pathology tests
n (%)	4045 (77)	2067 (78)	2340 (73)
Mean $ (SD)	69 (217)	41 (118)	94* (267)	<0.001
Imaging
n (%)	4839 (92)	2425 (91)	2911 (90)
Mean $ (SD)	496 (4527)	281 (837)	697* (5802)	<0.001
Management of pancreatic cancer complications
n (%)	4761 (90)	2439 (92)	2816 (87)
Mean $ (SD)	2860 (11,420)	1639 (4947)	4032* (15,140)	<0.001
Management of treatment-related side-effects
n (%)	4344 (83)	2300 (44)	2482 (47)
Mean $ (SD)	534 (1070)	311 (854)	676* (2875)	<0.001

^aNumber of patients in cohort with evidence of treatment or procedure.

^bMean cost of treatment/procedure among all patients in cohort.

^cComparison of mean costs between initial phase and metastatic phase.

Significantly higher results signified by *.

Table 5. Healthcare costs (PPPM) associated with management of pancreatic cancer complications.

Costs associated with management of	Total follow-up (n = 5262)	Initial phase (non-metastatic) (n = 2651)	Metastatic phase (n = 3227)	p-Value^c
Cholangitis or biliary obstruction (costs of ERCP, biliary bypass, and stent placement)
n (%)^a	1914 (36)	955 (36)	988 (31)
Mean $ (SD)^b	994 (5467)	760 (2871)	1272* (6789)	<0.001
Intractable ascites (costs of paracentesis and shunting)
n (%)	615 (12)	111 (4)	468 (15)
Mean $ (SD)	81 (1661)	9 (93)	221* (5329)	0.023
Depression (costs of antidepressants)
n (%)	1507 (29)	698 (26)	816 (25)
Mean $ (SD)	8 (33)	9 (28)	8 (35)	0.246
Gastric outlet obstruction/GI perforation (costs of gastric bypass, gastroduodenal stents, nasogastric tube treatment, and repair treatment)
n (%)	1371 (26)	643 (24)	696 (22)
Mean $ (SD)	1010 (8529)	577 (3724)	1403* (10,836)	<0.001
Cachexia (costs of cyproheptadine HCL, progesterone derivatives, growth hormones, anabolic steroids, nutritional supplementation)
n (%)	1188 (23)	442 (17)	704 (22)
Mean $ (SD)	63 (573)	46 (483)	80* (695)	0.031
Pain (costs of celiac plexus treatment, splanchnic nerve destruction treatment, epidural injection, opioids, NSAIDs)
n (%)	4128 (78)	2109 (80)	2368 (73)
Mean $ (SD)	254 (1803)	175 (1199)	342* (2299)	<0.001
Pancreatic insufficiency (costs of replacement pancreatic enzymes)
n (%)	1468 (28)	749 (28)	748 (23)
Mean $ (SD)	29 (93)	32* (99)	26 (92)	0.007
Skeletal metastases (costs of bisphosphonates)
n (%)	70 (1)	7 (0.3)	59 (2)
Mean $ (SD)	4 (62)	0.2 (6)	7* (92)	<0.001
Thromboembolic disease (costs of thrombectomy, embolectomy, inferior vena cava filter, low molecular weight heparin, warfarin)
n (%)	1228 (23)	402 (15)	791 (25)
Mean $ (SD)	559 (5136)	127 (1090)	850* (6519)	<0.001

^aNumber of patients in cohort with evidence of treatment for the complication.

^bMean cost of treatment among all patients in cohort.

^cComparison of mean costs between initial phase and metastatic phase.

Significantly higher results signified by *.

Table 6. All-cause healthcare resource use during follow-up. Initial treatment phase vs metastatic treatment phase.

	Initial phase (non-metastatic disease) (n = 2651)	Metastatic phase (n = 3227)	p-Value
Office visits
n	2569	2632
%	97*	82	<0.001
Rate^a	24.8	35.7*	<0.001
Outpatient visits
n	2506	2672
%	95*	83	<0.001
Rate^a	19.2	31.2*	<0.001
ER visits
n	1333	2109
%	50	65*	<0.001
Rate^a	1.4	2.8*	<0.001
Inpatient stays
n	1900	2879
%	72	89*	<0.001
Rate^a	1.5	3.4*	<0.001
Length^b	21	23*	0.002

^aEvents/person-year (compared using the exact binomial test).

^bMean length of all inpatient stays in days (compared using 2-sided t-test).

Significantly higher results signified by *.

Table 7. All-cause healthcare costs (PPPM) during follow-up. Initial treatment phase vs metastatic treatment phase.

Costs ($)	Initial phase (non-metastatic disease) (n = 2651)	Metastatic phase (n = 3227)	p-Value
Total costs, mean (SD), median	10,358 (13,026), 5982	21,637* (29,814), 13,611	<0.001
Office costs, mean (SD), median	1317 (2497), 288	1696* (2,781), 338	<0.001
Hospital outpatient costs, mean (SD), median	2862 (4945), 787	3262* (6620), 999	0.006
Emergency room costs, mean (SD), median	65 (176), 0	236* (636), 37	<0.001
Inpatient costs, mean (SD), median	5290 (10,789), 1250	15,130* (29,170), 5545	<0.001
Other costs, mean (SD), median	317 (1340), 52	499* (2199), 71	<0.001
Pharmacy costs, mean (SD), median	508 (844), 242	814* (1299), 323	<0.001

Significantly higher results signified by *.