Real-world treatment and healthcare resource utilization patterns among patients with advanced non-small cell lung cancer treated with amivantamab: a retrospective study using insurance claims data.

Background Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor-mutated (EGFRm) NSCLC, 84% of which are exon 19 deletions (Ex19del)/exon 21 substitutions (L858R). Unmet needs for patients treated with tyrosine kinase inhibitors (TKIs) for EGFRm (Ex19del/L858R) advanced NSCLC, including osimertinib, are relevant to US population health decision makers. Objectives To describe healthcare resource utilization (HRU) and costs by line of therapy (LOT) among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating first-line (1L) treatment. Methods IBM MarketScan® Research Databases (1/1/2010-1/31/2023) were used to select adult patients with advanced NSCLC initiating an EGFR-TKI during any LOT on/after 4/18/2018 (osimertinib approval; EGFRm Ex19del/L858R proxy). Per-patient-per-month (PPPM) all-cause HRU and costs were described in 1L, second-line (2L), and third-line (3L) overall and among subgroups receiving 1L osimertinib monotherapy or platinum-based chemotherapy (PBC) without immunotherapy, separately. Results The study included 409 patients with EGFRm advanced NSCLC (mean age, 60.5 years; 70.2% female). In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of >4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). Mean all-cause costs PPPM were $27 751 in 1L, $28 971 in 2L, and $31 251 in 3L. Among the 1L osimertinib monotherapy subgroup, mean PPPM costs were $27 610 in 1L, $35 501 in 2L, and $36 618 in 3L. Among the 1L PBC subgroup (n = 58), mean PPPM costs were $23 820 in 1L, $24 788 in 2L, and $23 348 in 3L. Discussion Among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating 1L, each successive LOT was shorter and more costly. Conclusions Findings highlight the importance of using the most effective 1L treatments to delay disease progression and reduce HRU and costs.

BackgroundApproximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor-mutated (EGFRm) NSCLC, 84% of which are exon 19 deletions (Ex19del)/exon 21 substitutions (L858R). Unmet needs for patients treated with tyrosine kinase inhibitors (TKIs) for EGFRm (Ex19del/L858R) advanced NSCLC, including osimertinib, are relevant to US population health decision makers.ObjectivesTo describe healthcare resource utilization (HRU) and costs by line of therapy (LOT) among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating first-line (1L) treatment.MethodsIBM MarketScan® Research Databases (1/1/2010-1/31/2023) were used to select adult patients with advanced NSCLC initiating an EGFR-TKI during any LOT on/after 4/18/2018 (osimertinib approval; EGFRm Ex19del/L858R proxy). Per-patient-per-month (PPPM) all-cause HRU and costs were described in 1L, second-line (2L), and third-line (3L) overall and among subgroups receiving 1L osimertinib monotherapy or platinum-based chemotherapy (PBC) without immunotherapy, separately.ResultsThe study included 409 patients with EGFRm advanced NSCLC (mean age, 60.5 years; 70.2% female). In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of >4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). Mean all-cause costs PPPM were 27 751in1L,28 971 in 2L, and 31 251in3L.Amongthe1Losimertinibmonotherapysubgroup,meanPPPMcostswere27 610 in 1L, 35 501in2L,and36 618 in 3L. Among the 1L PBC subgroup (n = 58), mean PPPM costs were 23 820in1L,24 788 in 2L, and $23 348 in 3L.DiscussionAmong patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating 1L, each successive LOT was shorter and more costly.ConclusionsFindings highlight the importance of using the most effective 1L treatments to delay disease progression and reduce HRU and costs.

Background: Human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (MBC) is associated with increased clinical and economic burden. Patients with brain metastases (BM) have significantly worse outcomes, however, limited data exist evaluating healthcare resource utilization (HCRU) among HER2+ MBC patients with BM. Objective: To describe treatment patterns and HCRU among HER2+ MBC patients with or without brain metastases who received HER2-targeted therapy using retrospective claims data. Methods: Data obtained from the IBM Watson HealthTM MarketScan commercial claims and Medicare Supplemental database from July 2012 to December 2018 were used to evaluate HER2+ MBC patients. We describe demographic and clinical characteristics, treatment patterns by line of therapy (LOT) by the presence or absence of BM, and HCRU. The first metastatic diagnosis date was the study initiation (index) date. HCRU outcomes per patient per year (PPPY) in the follow-up period after metastatic diagnosis were measured overall and by BM vs non-BM. These HCRU outcomes included inpatient (IP) services, total length of stay (LOS), emergency room (ER) services, and outpatient (OP) services. Results: A total of 4,509 patients were included. One-hundred and three (2.3%) patients had BM and 4,406 had no evidence of BM at index. However, 590 (13.1%) developed BM after study initiation. The mean age at index was 53.7 years. Median follow-up time was 23.2 months overall (22.1 months for patients with BM at index and 23.2 months for patients without BM at index). Median time on treatment (months) was 7.6, 7.2, and 6.2 for first line (1L), 2L, and 3L, respectively. Trastuzumab-based regimens were most used across all LOTs. Trastuzumab emtansine (T-DM1) use in 1L was 0.9% (2.4% in BM and 0.9% in non-BM patients). T-DM1 use increased in 2L (9.7%) and 3L (13.0%) and differed for BM vs non-BM patients in 2L (22.6% vs 7.7%) and 3L (25% vs 10.1%). Overall, lapatinib use ranged from 1.6% (1L) to 8.3% (3L). BM patients had a higher frequency of lapatinib use compared to non-BM patients (1L: 11.8% vs 1.2%; 2L: 20.5% vs 1.8%; 3L: 21.2% vs 5.1%). The mean number of IP services PPPY was 0.6 and higher for BM patients (1.2 vs 0.5). The mean total LOS PPPY was 2.7 days and BM patients had higher total LOS (8.6 vs 2.6 days) compared to non-BM patients. The average number of ER visits PPPY was 1.2 and BM patients had higher frequency of ER visits (2.5 vs 1.2). The mean number of OP services PPPY was 57.1; however, no obvious difference was observed between BM and non-BM patients (62.1 vs 56.9). Conclusions: Among HER2+ MBC patients, there is significantly higher HCRU among BM patients compared to patients without BM. This highlights the need for more effective systemic therapies that improve outcomes and reduce disease and healthcare system burden for HER2+ MBC patients, particularly those with BM. Citation Format: Chiemeka Ike, Naomi Schwartz, Andy Surinach, Yutong Liu, Kendra DeBusk, Thomas Walters. Real world treatment patterns and healthcare resource utilization among HER2+ metastatic breast cancer patients with and without brain metastases: A retrospective cohort study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-15.

Real World Treatment Patterns, Adverse Events and Healthcare Resource Utilization and Costs Among Chronic Lymphocytic Leukemia (CLL) Patients in the United States

Real-World Treatment Patterns, Outcomes, Health Care Resource Utilization and Cost Burden of Multiple Myeloma in South Korea Using the National Claims Data

e20646 Background: Among patients with non-small cell lung cancer (NSCLC), ~19-24% harbor epidermal growth factor receptor mutations (EGFRm). Amivantamab (AMI) was approved by the US Food and Drug Administration on 5/21/2021 for second-line (2L) patients with EGFR exon 20 insertions (Exon20Ins) advanced NSCLC who progressed after platinum-based chemotherapy (PBC), on 3/1/2024 for first-line (1L) EGFR Exon20Ins, and for 1L (8/20/2024) and 2L (9/19/2024) EGFR exon 19 deletion and L858R. Immunotherapy (IO) monotherapy (mono) has limited effectiveness in treating EGFRm advanced NSCLC and fails to add clinical benefit when used with PBC, yet increases toxicity risk. This study evaluates real-world treatment patterns and outcomes among patients receiving AMI. Methods: Komodo Research Data closed claims (1/1/2016-10/31/2023) were used to analyze adults with a lung cancer diagnosis (ICD-10-CM: C34) initiated on AMI on/after 5/21/2021 in 2L or later (2L+) for advanced NSCLC. Baseline brain/cerebral meninges (CNS) metastases were identified based on ≥1 diagnosis (ICD-10-CM: C79.3) in the continuous eligibility period before 1L initiation. Treatment patterns, including prior IO use with/without PBC, were described for patients initiating AMI in 2L, third-line (3L), and fourth-or-later line (4L+). Time to next treatment or death (TTNT-D) was evaluated for patients initiating AMI mono in 2L after PBC using Kaplan-Meier survival analysis. Results: A total of 126 patients initiated AMI in 2L+ (mean age: 60.2 years; 63.5% female), with 65 (51.6%) receiving AMI in 2L, 41 (32.5%) in 3L, and 20 (15.9%) in 4L+. Baseline CNS metastases were observed in 35.4% of 2L AMI patients (3L: 22.0%; 4L+: 35.0%). For patients initiating AMI in 2L, median follow-up duration was 6.5 months (3L: 5.9; 4L+: 6.8) [Table 1]. AMI mono was used in 92.3% of 2L patients (3L: 73.2%; 4L+: 80.0%). In combination therapy, AMI with osimertinib was most commonly used (2L: 4.6%, 3L: 19.5%; 4L+: 15.0%). Prior PBC use was observed in 83.1% of 2L AMI patients (3L: 100.0%; 4L+: 100.0%); 60.0% had prior IO use (3L: 63.4%; 4L+: 85.0%), including 53.8% IO+PBC (3L: 53.7%; 4L+: 60.0%) and 3.1% IO mono (3L: 4.9%; 4L+: 20.0%). Among 51 patients initiating AMI mono in 2L after PBC, median TTNT-D was 10.1 months. Conclusions: Among patients receiving AMI in 2L+, most initiated AMI mono after PBC, consistent with the FDA approval at the time of this study. Over half of patients had prior IO use, exposing them to suboptimal treatment and avoidable toxicity risk. Among patients receiving AMI mono in 2L following PBC, median TTNT-D was similar to median progression-free survival observed in clinical trials. 2L(n = 65) 3L(n = 41) 4L+(n = 20) Median follow-up, months 6.5 5.9 6.8 AMI mono, % 92.3 73.2 80.0 AMI combination, % 7.7 26.8 20.0 With osimertinib 4.6 19.5 15.0 Other combinations 3.1 7.3 5.0 Prior PBC use, % 83.1 100.0 100.0 Prior IO use, % 60.0 63.4 85.0 With PBC 53.8 53.7 60.0 Mono 3.1 4.9 20.0

Aims This study described treatment patterns, healthcare resource utilization (HRU) and costs among advanced or metastatic non-small cell lung cancer (a/mNSCLC) patients with different epidermal growth factor receptor (EGFR) mutation types. Materials and methods This retrospective study leveraged NeoGenomics NeoNucleus linked with IQVIA PharMetrics Plus between 01 January 2016 to 30 April 2021 (study period). Patients with evidence of a/mNSCLC between 01 July 2016 to 31 March 2021 (selection window) with EGFR test results indicating exon 19 deletion (exon19del), exon 21 L858R (L858R), or exon 20 insertion (exon20i) mutations were included; date of first observed evidence of a/mNSCLC was the index date. Treatment patterns, all-cause HRU and costs during ≥1 month follow-up were reported for each cohort (exon19del, L858R, and exon20i). Results A total of 106 exon19del, 75 L858R, and 13 exon20i patients met the study criteria. The prevalence of hospitalization was highest in the exon20i cohort (76.9%), followed by L858R (62.7%) and exon19del (55.7%) cohorts. A higher proportion of patients had evidence of hospice/end-of-life care in the exon20i (30.8%) and L858R (29.3%) cohorts relative to the exon19del cohort (22.6%). The exon20i cohort had higher median total healthcare costs per patient per month ($27,069) relative to exon19del ($17,482) and L858R ($17,763). EGFR tyrosine kinase inhibitors (TKI) were the most frequently observed treatment type for exon19del and L858R cohorts, while chemotherapy was the most observed treatment in exon20i cohort. Limitations The sample size for the study cohorts was small, thus no statistical comparisons were conducted. Conclusions This is one of the first real-world studies to describe HRU and costs among a/mNSCLC patients by specific EGFR mutation type. HRU and costs varied between EGFR mutation types and were highest among exon20i cohort, potentially reflecting higher disease burden and unmet need among patients with this mutation.

Real-World Treatment Patterns and Healthcare Resource Utilization in Patients with Waldenström Macroglobulinemia Initiating First-Line Treatment with Ibrutinib or Zanubrutinib

Real-World Drug Adherence, Persistence, and Healthcare Resource Utilization in Patients with Paroxysmal Nocturnal Hemoglobinuria in the USA: The Advantage Study

Real-World Treatment Patterns and Healthcare Resource Utilization (HRU) of Patients (Pts) with Paroxysmal Nocturnal Hemoglobinuria (PNH) Receiving Eculizumab in a US Population

EE98 Healthcare Resource Utilization and Costs Associated With Previously Treated Advanced Non-Small Cell Lung Cancer Patients Without EGFR Mutations or ALK Rearrangements in Korea

PCN314 REAL-WORLD PATIENT DEMOGRAPHICS, TREATMENT PATTERNS AND HEALTHCARE RESOURCE UTILIZATION (HRU) AMONG HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2 NEGATIVE (HER2-) ADVANCED BREAST CANCER (ABC) PATIENTS WITH BRCA1/2 MUTATIONS (BRCA1/2MUT)

15 Background: Few studies examine HRU of CLL, the most common hematologic malignancy in adults. This study describes HRU by the most common regimens among CLL patients (pts). Methods: A retrospective study using a large, national U.S. claims database from 1/2007-10/2013 was conducted. Adult CLL pts (≥2 claims for CLL) with ≥1 claim for systemic anticancer therapy (SACT) were identified; first SACT claim date was the index date. Pts had to have a CLL diagnosis ≤3 months (m) prior to the index date and be continuously enrolled (CE) in the health plan for 24m pre- and ≥6m post-index date. Pregnant pts and those with SACT in the pre-index period were excluded. A line of therapy (LOT) started with the first SACT; regimens included all agents received in the first 60 days. LOTs ended at the earliest of, start of a new drug, ≥60-day gap in receipt of initial regimen drugs, death or CE end. All-cause HRU was examined by regimen. Results: There were 946 CLL pts identified. Mean age was 68 years, 63% were male, and by insurance type, 41% were Medicare Advantage vs. 59% commercially insured. During the first LOT, 96% and 78% of pts had ≥1 office or hospital outpatient visit with mean per patient per month (PPPM) visits of 4.3 (standard deviation, SD = 2.8) and 2.2 (SD = 2.8), respectively. 31% and 25% had ≥1 ER visit or inpatient stay with mean PPPM visits of 0.2 (SD = 0.4) and 0.1 (SD = 0.3), respectively. Mean PPPM count of inpatient stay days was 1.4 (SD = 8.0). In first LOT, the top 3 regimens accounted for 56% of pts: FCR: fludarabine, cyclophosphamide, rituximab (19%); R: rituximab (19%); BR: bendamustine, rituximab (18%). During the study period, 318 pts (34%) started a second LOT. The top 3 LOT2 regimens accounted for 52% of pts: R (30%); BR (14%); chlorambucil (8%). Conclusions: HRU of CLL pts varied by initial regimen received. Future studies should examine influences of regimen choice and whether regimen choice is associated with differences in outcomes. [Table: see text]

There is limited information on the treatment trajectory and outcomes of patients with advanced cEGFRm NSCLC treated with osimertinib in routine clinical practice in Canada. By using and analyzing population-based administrative data and detailed chart abstraction in the province of Alberta, our objective was to capture Canadian-specific real-world treatment patterns, health outcomes, and healthcare resource utilization (HCRU) in advanced cEGFRm NSCLC patients who were (a) treated with osimertinib and (b) those receiving treatment after osimertinib. In our study cohort, we found that the overall survival rates for real-world patients receiving osimertinib were less favorable than those observed in clinical trials (24.0 versus 38.6 months). The attrition rate after osimertinib was substantial and high HCRU persisted across many years after diagnosis and treatment. This study provides important real-world evidence on contemporary survival, treatment patterns, and healthcare use among cEGFRm NSCLC patients treated with osimertinib and suggests that further research efforts are needed to improve therapeutic options in both the first and subsequent line settings.

BackgroundAn estimated 10–15% of non-small cell lung cancer (NSCLC) cases present with epidermal growth factor receptor mutation (EGFRm). While EGFR tyrosine kinase inhibitors (EGFR-TKIs) such as osimertinib have become first-line (1L) standard of care for these patients, limited chemotherapy use still occurs in real-world practice. Studies of healthcare resource use (HRU) and cost of care provide a means by which the value of various treatment regimens, healthcare efficiency, and disease burden can be assessed. These studies are important for population health decision makers and health systems that prioritize value-based care to drive population health.ObjectiveThe aim of this study was to descriptively assess HRU and costs among patients with EGFRm advanced NSCLC initiating 1L therapy in the United States.MethodsIBM MarketScan Research Databases (January 1, 2017 to April 30, 2020) were used to identify adult patients with advanced NSCLC, based on a diagnosis for lung cancer (LC) and initiation of 1L therapy or diagnosis of metastases within 30 days of the first LC diagnosis. All patients had ≥ 12 months of continuous insurance eligibility prior to the first LC diagnosis and initiated (in 2018 or after) an EGFR-TKI during any line of therapy to proxy EGFRm status. Per-patient-per-month all-cause HRU and costs were described during 1L for patients initiating 1L osimertinib or chemotherapy.ResultsA total of 213 patients with advanced EGFRm NSCLC were identified (mean age at 1L initiation: 60.9 years; 69.0% female). In 1L, 66.2% initiated osimertinib, 21.1% chemotherapy, and 12.7% another regimen. Mean 1L therapy duration was 8.8 months (osimertinib) and 7.6 months (chemotherapy), respectively. Among osimertinib recipients, 28% had an inpatient admission, 40% an emergency room (ER) visit, and 99% an outpatient visit. Among chemotherapy recipients, these proportions were 22%, 31%, and 100%. Mean monthly all-cause healthcare costs among osimertinib and chemotherapy patients were US$27,174 and US$23,343, respectively. Among osimertinib recipients, drug-related costs (including pharmacy and outpatient antineoplastic drug and administration costs) made up 61% (US$16,673) of total costs, inpatient costs 20% (US$5462), and other outpatient costs 16% (US$4432). In chemotherapy recipients, 59% (US$13,883) of total costs were drug-related, 5% (US$1166) were inpatient costs, and 33% (US$7734) other outpatient costs.ConclusionsHigher mean total cost of care was observed among patients receiving 1L TKI (osimertinib) than 1L chemotherapy in EGFRm advanced NSCLC. However, descriptive differences in type of spending and HRU were identified: higher inpatient costs and inpatient days for osimertinib versus higher outpatient costs for chemotherapy. Findings suggest that significant unmet needs may remain for 1L treatment of EGFRm NSCLC, and despite significant advances in targeted care, further individualized therapies are needed to balance benefits, risks, and total cost of care. Furthermore, observed descriptive differences in inpatient admissions may have implications for quality of care and patient quality of life, for which additional research is warranted.