Assistant Attending, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, NY, United States
Background: Approval of immuno-oncology (IO) agents have changed treatment paradigm for mRCC pts. While IO-based therapies have demonstrated improved survival, these can be associated with considerable HCRU and costs necessitating their examination in real-world practice
Methods: This retrospective claims analyses utilizing Optum Research Database included adult pts with mRCC diagnosis with receipt of P+A or I+N as LOT1 from January-2018 to May-2020 (first claim=index date). Patients were followed through August 2020. All eligible pts required continuous enrollment for minimum 6-months prior and 3-months post index date unless death occurred. Per-pt-per-month (PPPM) all-cause HCRU counts, and associated costs were examined during first 90 days (LOT1-90) and entire LOT1 duration.
Results: Study identified 507 pts (P+A=126, I+N=381). Average age was 67 years, 71% were male, mean NCI Charlson score was 2.4, and lung (55%) was the most common metastatic sites. P+A and I+N pts had similar baseline characteristics. Total % of pts with ambulatory visits was similar for P+A and I+N for LOT1-90 and entire LOT1 (99.2vs.100.0%, p=0.082 for both). During LOT1-90, we observed a lower % of P+A pts with ER visits and inpatient (IP) stay compared to I+N (34vs.48, p=0.008; 19vs.38, p< 0.001, respectively), and a shorter mean (SD) IP stay for P+A vs. I+N during LOT1-90 (1.9 (6.5)vs.5.6(13.24) days, p< 0.001). Similarly, P+A had lower mean PPPM ambulatory visits, IP stay, and ICU stay during LOT1-90 and entire LOT1 (Table). Mean PPPM total (medical + pharmacy) and medical costs were lower for P+A compared to I+N, but pharmacy costs were higher for P+A for both LOT1-90 and entire LOT-1 (Table).
Conclusions: This study noted significantly higher HCRU with I+N including higher mean PPPM ambulatory visits, IP stays, and ICU stays compared to P+A. Although, P+A had higher mean PPPM pharmacy costs, the total cost (medical plus pharmacy) were significantly lower compared to I+N.
