Nivolumab+Ipilimumab和Pembrolizumab+Axitinib作为晚期或转移性肾细胞癌一线治疗的相关实际医疗成本的长期时间趋势。

IF 3.2 Q2 ONCOLOGY Oncology and Therapy Pub Date : 2024-12-01 Epub Date: 2024-08-10 DOI:10.1007/s40487-024-00297-0

Ella Xiaoyan Du, Keith A Betts, Travis Wang, Sophie A Kitchen, Xuanhao He, Xin Yin, Sarah B Guttenplan, Karen Beauchamp, Andrew Delgado, Lisa Rosenblatt

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引用次数: 0

摘要

简介Nivolumab + ipilimumab (NIVO + IPI) 和 pembrolizumab + axitinib (PEM + AXI) 是晚期或转移性肾细胞癌（aRCC）的一线（1L）治疗方法，但其相关实际医疗费用的长期趋势尚不明确。我们比较了 24 个月内接受 1L NIVO + IPI 或 PEM + AXI 治疗的 aRCC 患者的实际医疗成本：我们在 Merative MarketScan 商业数据库和医疗保险补充数据库（01/01/2004 至 09/30/2021）中找到了接受 1L NIVO + IPI 或 PEM + AXI 治疗的 RCC 和继发性恶性肿瘤成人患者。在治疗开始后（指数日）至24个月的6个月间隔期内，对每位患者每月的全因和RCC相关医疗费用（未调整和调整后）进行了评估，并比较了NIVO + IPI和PEM + AXI两组之间的差异：在325例aRCC患者中，219例接受了NIVO + IPI治疗，106例接受了PEM + AXI治疗。根据患者的随访时间，第7-12个月的分析包括NIVO + IPI队列中的210名患者和PEM + AXI队列中的103名患者；第13-18个月的分析分别包括119名和48名患者；第19-24个月的分析包括81名和25名患者。NIVO + IPI 和 PEM + AXI 的 PPPM 未调整全因总成本在第 1-6 个月分别为 46,348 美元和 38,097 美元；在第 7-12 个月分别为 26,840 美元和 27,983 美元；在第 13-18 个月分别为 22,899 美元和 25,137 美元；在第 19-24 个月分别为 22,279 美元和 27,947 美元。NIVO + IPI 和 PEM + AXI 的 PPPM 未调整 RCC 相关费用在第 1-6 个月分别为 44,059 美元和 36,456 美元；在第 7-12 个月分别为 25,144 美元和 26,692 美元；在第 13-18 个月分别为 21,645 美元和 23,709 美元；在第 19-24 个月分别为 20,486 美元和 25,515 美元。与接受 PEM + AXI 治疗的患者相比，接受 NIVO + IPI 治疗的患者的 PPPM 费用下降得更快，因此在 19-24 个月期间，NIVO + IPI 的全因费用显著降低（差值为-10,914 美元[95% 置信区间-21,436 美元，-1091 美元]），RCC 相关费用在第 7-12 个月（-4747 美元[（-8929 美元，-512 美元]）和 19-24 个月（-10,261 美元[-20,842 美元，-421 美元]）调整后也显著降低。NIVO + IPI 相对于 PEM + AXI 的成本节约是由药物成本的差异驱动的，经过调整后，药物成本在第 7-12 个月显著降低（差异-5555 美元[全因]，-5689 美元[RCC 相关]）；第 13-18 个月（分别为-7217 美元和-6870 美元）；以及第 19-24 个月（-16682 美元和-16125 美元）：尽管在治疗的前 6 个月，1L NIVO + IPI 的实际 PPPM 医疗成本高于 PEM + AXI，但随后 NIVO + IPI 的相关成本迅速下降，第 7 至 24 个月的成本显著低于 PEM + AXI。

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Introduction: Nivolumab plus ipilimumab (NIVO + IPI) and pembrolizumab plus axitinib (PEM + AXI) are first-line (1L) treatments for advanced or metastatic renal cell carcinoma (aRCC), although the long-term trends in their associated real-world healthcare costs are not well defined. We compared the real-world healthcare costs of patients with aRCC who received 1L NIVO + IPI or PEM + AXI over 24 months.

Methods: Adults with RCC and secondary malignancy who initiated 1L NIVO + IPI or PEM + AXI were identified in the Merative MarketScan Commercial and Medicare Supplemental Databases (01/01/2004 to 09/30/2021). All-cause and RCC-related healthcare costs (unadjusted and adjusted) were assessed per patient per month (PPPM) at 6-month intervals post-treatment initiation (index date) up to 24 months, and differences between the NIVO + IPI and PEM + AXI cohorts were compared.

Results: Of 325 patients with aRCC, 219 received NIVO + IPI and 106 received PEM + AXI as the 1L treatment. According to patients' follow-up length, the analyses for months 7-12 included 210 patients in the NIVO + IPI cohort and 103 in the PEM + AXI cohort; months 13-18 included 119 and 48 patients, respectively; and months 19-24 included 81 and 25 patients. PPPM unadjusted all-cause total costs were $46,348 for NIVO + IPI and $38,097 for PEM + AXI in months 1-6; $26,840 versus $27,983, respectively, in months 7-12; $22,899 versus $25,137 in months 13-18; and $22,279 versus $27,947 in months 19-24. PPPM unadjusted RCC-related costs were $44,059 for NIVO + IPI and $36,456 for PEM + AXI in months 1-6; $25,144 versus $26,692, respectively, in months 7-12; $21,645 versus $23,709 in months 13-18; and $20,486 versus $25,515 in months 19-24. PPPM costs declined more rapidly for patients receiving NIVO + IPI compared to those receiving PEM + AXI, resulting in significantly lower all-cause costs associated with NIVO + IPI during months 19-24 (difference - $10,914 [95% confidence interval - $21,436, - $1091]) and RCC-related costs during months 7-12 (- $4747 [(- $8929, - $512]) and 19-24 (- $10,261 [- $20,842, - $421]) after adjustment. Cost savings for NIVO + IPI versus PEM + AXI were driven by differences in drug costs which, after adjustment, were significantly lower in months 7-12 (difference - $5555 [all-cause], - $5689 [RCC-related]); 13-18 (- $7217 and - $6870, respectively); and 19-24 (- $16,682 and - $16,125).

Conclusion: Although the real-world PPPM healthcare costs of 1L NIVO + IPI were higher compared with PEM + AXI in the first 6 months of treatment, the costs associated with NIVO + IPI rapidly declined thereafter, resulting in significantly lower costs vs. PEM + AXI from months 7 to 24.

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来源期刊

Oncology and Therapy ONCOLOGY-

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6 weeks

期刊介绍： Now indexed in PubMed Aims and Scope Oncology and Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality pre-clinical, clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Oncology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Rapid Publication The journal’s rapid publication timelines aim for a peer review decision within 2 weeks of submission. If an article is accepted it will be published online 3-4 weeks from acceptance. These rapid timelines are achieved through the combination of a dedicated in-house editorial team, who closely manage article workflow, and an extensive Editorial and Advisory Board who assist with rapid peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. 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