Care Pathway of Lung Cancer and Melanoma Patients Treated With Immune Checkpoint Inhibitors (ICI) in Hospital at Home and Administration Costs in France in 2021 and 2022

OBJECTIVES: Hospitalization at home (HAH), a facility delivering hospital care at home, constitutes an alternative to hospitalization for ICI administration. The study objective was to describe the role and cost of HAH in the ICI administration to lung cancer, metastatic and adjuvant melanoma patients in France in 2021 and 2022.

METHODS: Through French national hospital databases, all patients with at least one ICI administration in 2021 and 2022 were identified with a retrospective chain of all ICI administration stays until 2016. Two cohorts of patients were analyzed: patients with all their administrations in Day Care Unit (DCU) and patients with at least one administration in HAH. A descriptive analysis characterized patients, centers, "HAH patients" care pathways (based on treatment sequences clustering algorithms (TAK)) and administration costs in the French statutory health insurance perspective.

RESULTS: In 2021-2022, 330 lung cancer patients (0.6% of all ICI lung cancer patients), 69 metastatic (1%) and 42 adjuvant melanoma (1.3%) patients received their immunotherapy in HAH, mainly in 4 regions. Time between 1^st DCU to 1^st HAH administration was 304, 381 and 107 days for lung cancer, metastatic and adjuvant melanoma patients respectively, and between 1^st and last HAH administration, 271, 244 and 166 days. During the HAH administration period, 192 lung cancer patients (59.1%), 24 metastatic melanoma patients (42.1%) and 14 adjuvant melanoma patients (35%) received their administrations exclusively in HAH whereas the others alternated between HAH or DCU. The mean cost per administration differed according to indications, patients’ characteristics and regions of care: 346, 290 and 278 euros per administration for lung cancer, metastatic and adjuvant melanoma respectively.

CONCLUSIONS: In 2021-2022, HAH ICI administrations remained very limited with a variety of patients care pathways. The possibilities for developing HAH must be explored in order to meet the government's objective of developing home administrations.