PCN53 Grade 3/4 Adverse Event (AE) Costs of Nivolumab Plus Ipilimumab (N+I) Versus Nivolumab Plus Cabozantinib (N+C) and Pembrolizumab Plus Axitinib (P+A) for Previously Untreated Advanced Renal Cell Carcinoma (aRCC)

Abstract

This study assessed the grade 3/4 AE costs of N+I, N+C, and P+A from CheckMate-214 (CM-214), CheckMate-9ER (CM-9ER), and KEYNOTE-426 (KN-426), respectively. Grade 3/4 AE rates were obtained from individual patient-level data from CM-214 (restricted to median follow-up [RmFU], 13.1 months), CM-9ER (RmFU, 12.8 months), and published results of the KN-426 trial (mFU, 12.8 months). Per-patient all-cause and treatment-related (TR) grade 3/4 AE costs were calculated for AEs reported in ≥20% of patients. Per-patient costs were calculated by multiplying grade 3/4 AE incidence rates by the respective unit costs from the US 2017 Healthcare Cost and Utilization Project database, inflated to 2020 USD. N+I was associated with the lowest total per-patient all-cause and TRAE costs of compared treatments. Total per-patient all-cause AE costs for patients treated with N+I, N+C, and P+A were $6900, $10,892, and $11,332, and total TRAE costs were $741, $2722, and $4440, respectively. Lower total all-cause AE cost difference for N+I versus N+C and P+A were largely driven by differences in hypertension ($193 vs $966 and $1685), increased ALT ($553 vs $834 vs and $1701), hypophosphatemia ($0 vs $2466 and $721), and increased AST ($412 vs $671 and $1105), respectively. Lower TRAE costs for N+I versus N+C and P+A were largely driven by differences in hypertension ($39 vs $768 and $1490), increased ALT ($389 vs $399 and $1031), palmar-plantar erythrodysesthesia syndrome ($0 vs $486 and $332), and increased AST ($280 vs $266 and $575), respectively. Patients with aRCC treated with N+I had lower grade 3/4 all-cause and TRAE costs than those treated with N+C or P+A; N+C had lower costs versus P+A. These results suggest that N+I and N+C have a more favorable benefit-risk profile and offer clinicians and payers a therapeutic option that reduces clinical and economic burden in this population.