Health care resource use for modern first-line treatments in metastatic renal cell carcinoma Journal Article
| Authors: | Shah, N. J.; Shinde, R.; Moore, K. J.; Sainski-Nguyen, A.; Le, L. B.; Cao, F.; Song, R.; Singhal, P.; Motzer, R. J. |
| Article Title: | Health care resource use for modern first-line treatments in metastatic renal cell carcinoma |
| Abstract: | This cohort study investigates health care resource use, costs, and outcomes for first-line pembrolizumab plus axitinib or ipilimumab plus nivolumab among patients with metastatic renal cell carcinoma. Key Points: Question: What are the health care resource use, associated costs, and clinical outcomes for patients with metastatic renal cell carcinoma (mRCC) receiving first-line ipilimumab plus nivolumab (I+N) or pembrolizumab plus axitinib (P+A)? Findings: In this cohort study among 507 patients with mRCC, including 126 patients receiving P+A and 381 patients receiving I+N, treatment with P+A was associated with longer time on treatment and time to first emergency department visit and inpatient stay. Total adjusted all-cause per-patient, per-month costs were similar between groups, but 12-month estimated costs were higher for patients receiving P+A. Meaning: This study found differences in costs associated with clinical use of mRCC treatments. These findings suggest that clinicians and patients should be aware of and consider cost differences in determining treatment selection. Importance: Immuno-oncology agents have changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). Such therapies improve survival but can impose considerable health care resource use (HCRU) and associated costs, necessitating their examination. Objective: To compare HCRU, costs, and clinical outcomes among patients receiving first-line pembrolizumab plus axitinib (P+A) or ipilimumab plus nivolumab (I+N). Design, Setting, and Participants: This retrospective cohort study used data from an administrative claims database on patients with mRCC receiving first-line P+A or I+N that was initiated between January 2018 and May 2020. Data were analyzed from February 2021 to July 2022. Exposure: First-line P+A or I+N. Main Outcome and Measures: HCRU and costs during the first 90 days, full first-line treatment, and full follow-up periods were assessed. Using Kaplan-Meier analysis, time on treatment, overall survival, time to first emergency department (ED) visit, and time to first inpatient stay were compared. Results: Among 507 patients, there were 126 patients receiving P+A (91 male [72.2%]; mean [SD] age, 67.93 [9.66] y) and 381 patients receiving I+N (271 male [71.1%]; mean [SD] age, 66.52 [9.94] years). The median time on treatment was longer for the P+A compared with I+N group (12.4 months [95% CI, 8.40 months to not estimable] vs 4.1 months [95% CI, 3.07 to 5.30 months]; P <.001). The median time to first ED visit was longer for the P+A than I+N group (7.2 months [95% CI 3.9 to 11.1 months ] vs 3.3 months [95% CI, 2.6 to 3.9 months]; P =.005), as was time to first inpatient stay (9.0 months [95% CI 6.5 months to not estimable] vs 5.6 months [95% CI, 3.9 to 7.9 months]; P =.02). During the first 90 days, a lower proportion of the P+A than N+I group had ED visits (43 patients [34.1%] vs 182 patients [47.8%] and inpatient stays (24 patients [19.1%) vs144 patients [37.8%]; P <.001). During full follow-up, mean total adjusted costs were similar for P+A and I+N groups, but adjusted 12-month estimated total costs were higher for P+A than I+N groups ($325 574 vs $ 263 803; P =.03). Conclusions and Relevance: In this study, treatment with P+A was associated with longer time on treatment, time to first ED visit, and inpatient stay, while 12-month estimated costs were higher for the P+A group. This is among the first clinical studies to evaluate economic burden associated with modern treatments for mRCC. |
| Keywords: | aged; prospective studies; incidence; confidence intervals; medicare; length of stay; chi square test; health care costs; ambulatory care facilities; descriptive statistics; middle age; treatment outcomes; kaplan-meier estimator; retrospective design; antibodies, monoclonal -- therapeutic use; severity of illness indices; human; male; female; health resource utilization; protein kinase inhibitors -- therapeutic use; economic aspects of illness; nivolumab -- therapeutic use; immune checkpoint inhibitors -- therapeutic use; renal cell carcinoma, metastatic -- therapy; renal cell carcinoma, metastatic -- economics; emergency room visits |
| Journal Title: | JAMA Network Open |
| Volume: | 7 |
| Issue: | 7 |
| ISSN: | 2574-3805 |
| Publisher: | American Medical Association |
| Date Published: | 2024-07-01 |
| Start Page: | e2422674 |
| Language: | English |
| DOI: | 10.1001/jamanetworkopen.2024.22674 |
| PROVIDER: | EBSCOhost |
| PROVIDER: | cinahl plus with full text |
| PMCID: | PMC11273232 |
| PUBMED: | 39052293 |
| DOI/URL: | |
| Notes: | MSK corresponding author is Neil Shah -- Source: CINAHL Plus with Full Text |
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