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Economic Analysis of Adjuvant Chemoradiotherapy Compared with Chemotherapy in Resected Pancreas Cancer

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Population-based survival and costs of pancreas adenocarcinoma patients receiving adjuvant chemoradiation and chemotherapy following pancreaticoduodenectomy are poorly understood.

Methods

This retrospective cohort study used linked administrative and pathological datasets to identify all patients diagnosed with pancreas adenocarcinoma and undergoing pancreaticoduodenectomy in Ontario between April 2004 and March 2014, who received postoperative chemoradiation or chemotherapy. Stage and margin status were defined by using pathology reports. Kaplan–Meier and Cox proportional hazards regression survival analyses were used to determine associations between adjuvant treatment approach and survival, while stratifying by margin status. Median overall health system costs were calculated at 1 and 3 years for chemoradiation and chemotherapy, and differences were tested using the Kruskal–Wallis test.

Results

Among 709 patients undergoing pancreaticoduodenectomy for pancreas cancer during the study period, the median survival was 21 months. Median survival was 19 months for chemoradiation and 22 months for chemotherapy. Patients receiving chemoradiation were more likely to have positive margins: 47.7% compared with 19.2% in chemotherapy. After stratifying by margin status and controlling for confounders, adjusted hazard ratio of death were not statistically different between chemotherapy and chemoradiation [margin positive, hazard ratio (HR) = 0.99, 95% confidence interval (CI) = 0.88–1.27; margin negative, HR 0.95, 95% CI 0.91–1.18]. Overall 1-year health system costs were significantly higher for chemoradiation (USD $70,047) than chemotherapy (USD $54,005) (p ≤ 0.001).

Conclusions

Chemotherapy and chemoradiation yielded similar survival, but chemoradiation resulted in higher costs. To create more sustainable healthcare systems, both the efficacy and costs of therapies should be considered.

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Acknowledgment

Parts of this study were presented at the 2019 American Society of Clinical Oncology Gastrointestinal Cancers Symposium in San Francisco, CA and 2019 Society of Surgical Oncology Annual Cancer Symposium in San Diego, CA.

Disclaimers This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

Authors for the pancreas cancer population outcomes research group consists of

Mina Siqqidui, MD2, Qing Li, MMath3, Maryam Elmi, MD4, Elizabeth Shin, MD1, Eugene Hsieh, MD12, and Nik Goyert, MSc2, 1Faculty of Medicine, University of Toronto, Toronto, Canada. 2Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. 3ICES, Toronto, Canada. 4Department of General Surgery, Mansoura University Hospitals, Mansoura, Egypt.

Funding

This work was funded by the Sherif and MaryLou Hanna Chair in Surgical Oncology Research and the Cancer Research Society.

Author information

Author notes

  1. Nivethan Vela and Laura E. Davis share first authorship.

  2. Nicole Mittmann and Natalie G. Coburn share senior authorship of this work.

Authors and Affiliations

  1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Nivethan Vela MSc

  2. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Laura E. Davis MSc, Craig C. Earle MD, MSc, Nicole Mittmann PhD & Natalie G. Coburn MD, MPH

  3. Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada

    Stephanie Y. Cheng MSc, Ying Liu MSc, Lawrence Paszat MD, MS, Craig C. Earle MD, MSc, Nicole Mittmann PhD & Natalie G. Coburn MD, MPH

  4. Department of General Surgery, Mansoura University Hospitals, Mansoura, Egypt

    Ahmed Hammad MD

  5. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Daniel J. Kagedan MD, MSc, Lev D. Bubis MD, MHS, MSc & Natalie G. Coburn MD, MPH

  6. Division of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Lawrence Paszat MD, MS & Sten Myrehaug MD

  7. Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, Canada

    Craig C. Earle MD, MSc

  8. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Alyson L. Mahar PhD

  9. Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada

    Nicole Mittmann PhD

Authors
  1. Nivethan Vela MSc
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  2. Laura E. Davis MSc
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Consortia

for the Pancreas Cancer Population Outcomes Research Group

  • Mina Siqqidui MD
  • , Qing Li MMath
  • , Maryam Elmi MD
  • , Elizabeth Shin MD
  • , Eugene Hsieh MD
  •  & Nik Goyert MSc

Contributions

NV and LED: conceptualization, investigation, methodology, original draft, review and editing. SYC, YL and QL: data curation, formal analysis, methodology and review and editing. AH: methodology, review and editing. DJK: data curation, methodology, validation, review and editing. LP, CCE and LDB: validation, visualization, review and editing. MS, ME, ES, and NG: data curation, methodology, validation and editing. SM: methodology, validation, visualization, review and editing ALM: methodology, review and editing. NM and NGC: conceptualization, data curation, funding acquisition, methodology, resources, review and editing.

Corresponding author

Correspondence to Natalie G. Coburn MD, MPH.

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Disclosure

All authors declare no competing interests except NGC who received salary support from Cancer Care Ontario as the Clinical Lead of Patient Reported Outcomes and Symptom Management.

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Appendix

Appendix

See Tables 5 and 6.

Table 5 Defining patients with pancreas cancer who underwent pancreaticoduodenectomy
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Table 6 Codes for chemotherapy and radiotherapy
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Vela, N., Davis, L.E., Cheng, S.Y. et al. Economic Analysis of Adjuvant Chemoradiotherapy Compared with Chemotherapy in Resected Pancreas Cancer. Ann Surg Oncol 26, 4193–4203 (2019). https://doi.org/10.1245/s10434-019-07808-8

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  • DOI: https://doi.org/10.1245/s10434-019-07808-8

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