MINI01.19: Cost Analysis of Pemetrexed-Platinum with Maintenance vs. Paclitaxel-Carboplatin-Bevacizumab with Maintenance in Patients with Lung Cancer

Abstract

Given minimal differences in efficacy between pemetrexed and bevacizumab in first-line treatment to progression, based on the PRONOUNCE and POINTBREAK Phase III studies, evidence-based decision making regarding optimum treatment strategy may be driven by potential differences in healthcare resource utilization (HCRU) and costs. Real-world data from commercial and Medicare supplemental insurance claims in the U.S. were used to compare HCRU and costs associated with continuation maintenance with bevacizumab and pemetrexed. Insurance claims data from Truven Health Analytics Marketscan Databases were used to identify lung cancer patients who initiated treatment with pemetrexed-platinum or paclitaxel-carboplatin-bevacizumab between March 2009 and June 2013 and continued monotherapy following ≥4 administrations of first-line treatment. Patients were followed up to 12 months from treatment initiation to identify subsequent claims for healthcare services. HCRU and costs were evaluated from initiation of first-line treatment to end of 12-month follow-up (or death or disenrollment) and from initiation of first-line treatment through end of maintenance. Propensity score bin bootstrapping methods were used to adjust for demographic and clinical differences between treatment cohorts. The pemetrexed-platinum maintenance cohort included 509 patients (104 cisplatin, 405 carboplatin), and the paclitaxel-carboplatin-bevacizumab maintenance cohort included 177 patients. Pemetrexed-platinum patients were older (62.7 vs. 60.5, p<0.009), more likely to live in the Northeast (21.6% vs 9.04%, p<0.003), and had higher comorbidity burden (mean Charlson Comorbidity Index 2 vs. 1.7, p<0.014). Pemetrexed-platinum patients were more likely to have pulmonary heart disease (11.0% vs. 4.52%, p=0.038), chronic pulmonary disease (47.0% vs. 35.0%, p=0.023), and brain metastasis (23.0% vs. 13.6%, p=0.028). In the 6 months prior to treatment initiation, pemetrexed-platinum patients were more likely to have had an emergency room visit (34.4% vs. 21.5% and inpatient stay (48.7% vs. 33.9%), and had higher total costs ($38,796 vs. $31,161, p=0.014). During the period from treatment initiation to end of maintenance, mean total costs per patient per month were $2,600 (95% CI [$2560, 2640]) lower for pemetrexed-platinum patients compared to paclitaxel-carboplatin-bevacizumab patients, primarily due to lower outpatient costs. In the 12-month period following initiation of first-line treatment, mean total costs per patient per month were $1,653 (95% CI, [$1617, $1688]) lower for pemetrexed-platinum patients, again due to lower outpatient costs. Mean total costs per patient per month were significantly lower for pemetrexed-platinum patients compared to paclitaxel-carboplatin-bevacizumab patients in the setting of first-line treatment to progression in lung cancer patients with commercial or Medicare supplemental health insurance.