Patients receiving first-line pembrolizumab plus axitinib for metastatic renal cell carcinoma (mRCC) have lower health care resource utilization (HCRU) than patients receiving first-line ipilimumab plus nivolumab, according to research presented at IKCS North America 2022.
To examine use of these therapies in a real-world setting, researchers analyzed 507 patients from the Optum Research Database who had a first claim associated with an mRCC diagnosis between July 2017 and August 2020.
The patients received pembrolizumab plus axitinib (n=126) or ipilimumab plus nivolumab (n=381) as first-line therapy. The mean age was 67.93 years in the pembrolizumab-axitinib group and 66.52 years in the ipilimumab-nivolumab group. Most patients in both groups were men (72.22% and 71.13%, respectively).
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More than half of patients had lung metastasis — 55.56% in the pembrolizumab-axitinib group and 54.33% in the ipilimumab-nivolumab group. Patients also had bone metastasis (32.54% and 33.60%, respectively), lymph node metastasis (25.40% and 27.82%), and liver metastasis (11.90% and 16.54%).
During the first 90 days of treatment, pembrolizumab-axitinib recipients had lower HCRU than ipilimumab-nivolumab recipients. This included:
- Fewer inpatient stays (mean, 0.09 and 0.23, respectively; P <.001)
- Shorter hospitalizations (mean, 0.80 days vs 2.24 days; P <.001)
- Fewer inpatient stays with a visit to the intensive care unit (mean, 0.05 vs 0.10; P =.015)
- Fewer ambulatory visits (mean, 6.68 vs 7.52; P =.029).
Medical costs in the first 90 days were lower in the pembrolizumab-axitinib group than in the ipilimumab-nivolumab group (mean, $21,123 and $48,436, respectively; P <.001). However, pharmacy costs in the first 90 days were higher in the pembrolizumab-axitinib group (mean, $15,840 vs $502; P <.001).
Overall, pembrolizumab-axitinib was associated with lower total healthcare costs in the first 90 days than ipilimumab-nivolumab (mean, $36,963 vs $48,939; P <.001).
The researchers also looked at HCRU over the entire follow-up period. The median follow-up was 8.72 months for the pembrolizumab-axitinib group and 10.77 months for the ipilimumab-nivolumab group.
Over the follow-up period, patients in the pembrolizumab-axitinib group had significantly fewer inpatient stays (P <.001), shorter hospitalizations (P <.001), and fewer inpatient stays with a visit to the intensive care unit (P =.013). There was no significant difference between the groups for ambulatory visits, however.
Medical costs over the entire follow-up period were lower in the pembrolizumab-axitinib group (P <.001), and pharmacy costs over the entire period were higher in the pembrolizumab-axitinib group (P <.001). There was no significant difference between the groups for total health care costs.
These data indicate that pembrolizumab-axitinib is associated with lower HCRU and costs, but prospective studies are needed to confirm these findings, the researchers concluded.
Disclosures: Some study authors are employed by Optum and Merck Sharp & Dohme LLC.
Reference
Shah NJ, Shinde R, Moore KJ, et al. Healthcare resource utilization (HCRU) and costs in metastatic renal cell carcinoma (mRCC) patients receiving first-line (LOT1) pembrolizumab + axitinib (P+A) or ipilimumab + nivolumab (I+N). Presented at IKCS North America 2022. November 4-5, 2022. Abstract 22.
