Randomized clinical trials in aNSCLC demonstrated that 2L IO prolonged overall survival and lowered AE rates compared with 2L CHEMO. However, real-world (RW) evidence from clinical practice is limited, and the potential cost benefits of lower AE rates have not been examined. Here, we report average costs per patient (pt) associated with grade 3-4 AEs during 2L treatment with IO and CHEMO in aNSCLC from a US payer perspective.
AEs in pts treated with 2L IO or CHEMO for aNSCLC (Mar 2015-Dec 2017) were abstracted from US electronic health records in COTA’s database. Hospitalization costs for each ICD-10 code associated with the management of a grade 3-4 AE during treatment were estimated using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample 2017 dataset.
Of 596 pts in the analysis, 276 received IO (199 nivolumab) and 320 received CHEMO. The proportion of IO- vs CHEMO-treated pts was higher for pts aged <75 years (79% vs 71%), men (54% vs 47%), and current/former smokers (92% vs 83%); proportions in the IO and CHEMO groups were similar for non-squamous histology (84% vs 83%) and history of brain metastases (37% vs 37%). Overall, 40 (14.5%) IO-treated pts and 68 (21.3%) CHEMO-treated pts had grade 3-4 AEs, resulting in average costs per pt of $9,421 and $15,677, respectively. The main cost and event drivers in both treatment groups were alanine aminotransferase elevation (IO: 36% of total costs [32% of grade 3-4 AEs], CHEMO: 25% [21%]) and leukocytosis, indicative of infection (IO: 22% [28%], CHEMO: 33% [41%]). Table shows average cost per pt in selected subgroups. Table: 74P Average cost of grade 3-4 AEs per patient (Pt)IO (n = 276) CHEMO (n = 320) n Average Cost per Pt n Average Cost per Pt <65 y 107 $6,877 114 $17,203 ≥65 y 169 $11,033 206 $14,832 Male 150 $4,417 150 $10,460 Female 126 $15,379 170 $20,279 White 176 $9,265 233 $17,547 Former/current smoker 255 $7,973 265 $17,292 History of brain metastasis 101 $9,760 117 $20,219 No history of brain metastasis 175 $9,226 203 $13,059 Squamous 43 $3,096 53 $18,749 Nonsquamous 233 $10,634 267 $15,181
In this RW analysis in pts with aNSCLC, 2L IO was associated with lower costs for the management of grade 3-4 AEs than 2L CHEMO.
Writing assistance was provided by Roland Tacke, PhD, of Evidence Scientific Solutions Inc, funded by Bristol-Myers Squibb.
Bristol-Myers Squibb.
Bristol-Myers Squibb.
C.K. Wang: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA. K. Gupte-Singh: Full / Part-time employment: Bristol-Myers Squibb. A.J. Belli: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA. D.C. Lane: Shareholder / Stockholder / Stock options, Was an employee at Bristol-Myers Squibb while this work was done and recently joined COTA: Bristol-Myers Squibb. A. Lakshmanan: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA. A.D. Norden: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA.