Healthcare resource utilization (HCRU) and costs for patients (pts) with metastatic renal cell carcinoma (mRCC) receiving first-line (LOT1) pembrolizumab plus axitinib (P+A) or ipilimumab plus nivolumab (I+N).

Abstract

4528 Background: Approval of immuno-oncology (IO) agents have changed treatment paradigm for mRCC pts. While IO-based therapies have demonstrated improved survival, these can be associated with considerable HCRU and costs necessitating their examination in real-world practice. Methods: This retrospective claims analyses utilizing Optum Research Database included adult pts with mRCC diagnosis from July-2017 to Aug-2020 and received P+A or I+N as LOT1 from Jan-2018 to May-2020 (first claim=index date). All eligible pts required continuous enrollment for minimum of 6-months prior and 3-months post the index date unless death occurred. All-cause HCRU counts, and associated costs were examined during the first 90 days (LOT1-90) and entire LOT1 duration and reported as overall and per-pt-per-month (PPPM) estimates. Results: The study identified 507 pts (P+A=126, I+N=381). Average age of the entire cohort was 67 years, 71% were male, mean NCI Charlson score was 2.4, and lung (55%) and bone (33%) were the most common metastatic sites. Mean (SD) distance from mRCC diagnosis to index date was 97 (172) days. Pts with P+A and I+N had similar baseline characteristics. Total % of pts with ambulatory visits was similar for P+A and I+N for LOT1-90 and entire LOT1 (99.2 vs. 100.0%, p=0.082 for both). During LOT1-90, we observed a lower % of pts on P+A with ER visits and inpatient (IP) stay compared to I+N (34 vs. 48, p=0.008; 19 vs. 38, p<0.001, respectively). We also observed a shorter mean (SD) IP stay for P+A vs. I+N during LOT1-90 (1.9 (6.5) vs. 5.6 (13.24) days, p<0.001). Similarly, P+A had lower mean PPPM ambulatory visits, IP stay, and ICU stay during both LOT1-90 and entire LOT1 (Table). In addition, mean PPPM total (medical + pharmacy) and mean PPPM medical costs were lower for P+A compared to I+N, but mean PPPM pharmacy costs were higher for P+A for both LOT1-90 and entire LOT-1 (Table). Conclusions: This study noted significantly higher HCRU with I+N including higher mean PPPM ambulatory visits, IP stays, and ICU stays compared to P+A. Although, P+A had higher mean PPPM pharmacy costs, the total medical plus pharmacy costs were significantly lower compared to I+N. [Table: see text]