The Financial Burden of Pancreatic Enzyme Replacement Therapy for Patients With Resected Pancreatic Cancer.

BACKGROUND: Post-pancreatectomy exocrine insufficiency is common after resection for pancreatic cancer and requires pancreatic enzyme replacement therapy (PERT). We sought to determine the out-of-pocket cost of PERT and the association between PERT and survival. METHODS: The SEER-linked Medicare database was queried for patients with pancreatic cancer who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) from 2010 to 2019. Cumulative out-of-pocket costs were calculated and stratified by procedure and radiation. RESULTS: 11,854 Medicare beneficiaries with resected pancreatic cancer were identified, 4,653 (39%) required PERT and 7,201 (61%) did not. Median age was 73.0, 50.6% were female and 83.6% White. 25.9% underwent DP and 74.1% underwent PD; 7% received neoadjuvant radiation while 23.5% received adjuvant radiation. Logistic regression demonstrated that female sex (OR 1.25, 95% CI 1.16-1.35, p < 0.001), neoadjuvant radiation (OR 1.93, 95% CI 1.67-2.24, p < 0.001), and PD (OR 2.45, 95% CI 2.23-2.7, p < 0.001) were risk factors for requiring PERT. Patients without subsidies who underwent DP paid a cumulative $4,736 out-of-pocket for PERT after 5 years, those who underwent PD paid $5,601 out-of-pocket. CONCLUSIONS: Nearly 40% of Medicare beneficiaries took PERT after resection for pancreatic cancer and paid thousands in out-of-pocket costs. While a conservative estimate, these findings highlight the importance of addressing this financial burden to patients.