Temporal Trends in Healthcare Costs Associated with First-Line (1L) Nivolumab + Ipilimumab (N+I) and Pembrolizumab + Lenvatinib (P+L) in Advanced or Metastatic Renal Cell Carcinoma (aRCC)
Moderator
Lisa C Rosenblatt, MPH, MD, Bristol Myers Squibb, East Brunswick, NJ, United States
Speakers
Xiaoyan Du, Analysis group, Los Angeles, CA, United States; Keith Betts, PhD, Analysis Group, Torrance, CA, United States; Travis Wang, MSc, Boston, MA, United States; sydney ng, Analysis Group, Los Angeles, CA, United States; Sarah Guttenplan; Renuka Kandikatla
OBJECTIVES: While immuno-oncology combinations have become the standard of care for aRCC, real-world cost comparisons remain limited. This study aims to assess and compare all-cause and RCC-related healthcare costs for patients receiving 1L N+I vs. P+L treatment for aRCC.
METHODS: Utilizing US IQVIA PharMetrics® Plus claims data (1/1/2015-12/31/2023), this retrospective cohort study identified adult patients with aRCC who initiated 1L treatment with N+I (from 04/16/2018) or P+L (from 08/10/2021) and had ≥6 months of continuous enrollment before and after index date (1L initiation). Monthly all-cause and RCC-related healthcare costs, including medical service and drug costs, were assessed at 6-month intervals up to 24 months. Multivariable generalized linear models with a Tweedie distribution estimated adjusted cost differences while controlling for baseline characteristics (age, sex, region, insurance type, comorbidities, metastatic sites, and time from aRCC diagnosis to 1L initiation).
RESULTS: The analysis included 780 patients in months 1-6, decreasing to 341 by months 19-24. Median ages were 59 for N+I and 58.5 for P+L, with similar baseline characteristics across cohorts. Adjusted analyses demonstrated that N+I was associated with $5,270 lower monthly costs than P+L in months 1-6 (95% CI: -$10,020, -$521; p=0.030). These cost differences expanded over time, reaching -$13,870 (95% CI: -$18,109 -$9,631; p<0.001) in months 7-12, -$11,606 (95% CI: -$19,171, -$4,042; p=0.003) in months 13-18, and -$13,575 (95% CI: -$27,810, $661; p=0.062) in months 19-24. RCC-related costs followed similar trends, with lower drug costs for N+I as the main driver of savings, while medical service costs remained consistent between groups.
CONCLUSIONS: N+I is a first-line treatment option for aRCC that offers long-term healthcare-related cost-savings and sustainable economic value, largely driven by drug cost differences. Further research with a larger sample and longer follow-up is warranted.
METHODS: Utilizing US IQVIA PharMetrics® Plus claims data (1/1/2015-12/31/2023), this retrospective cohort study identified adult patients with aRCC who initiated 1L treatment with N+I (from 04/16/2018) or P+L (from 08/10/2021) and had ≥6 months of continuous enrollment before and after index date (1L initiation). Monthly all-cause and RCC-related healthcare costs, including medical service and drug costs, were assessed at 6-month intervals up to 24 months. Multivariable generalized linear models with a Tweedie distribution estimated adjusted cost differences while controlling for baseline characteristics (age, sex, region, insurance type, comorbidities, metastatic sites, and time from aRCC diagnosis to 1L initiation).
RESULTS: The analysis included 780 patients in months 1-6, decreasing to 341 by months 19-24. Median ages were 59 for N+I and 58.5 for P+L, with similar baseline characteristics across cohorts. Adjusted analyses demonstrated that N+I was associated with $5,270 lower monthly costs than P+L in months 1-6 (95% CI: -$10,020, -$521; p=0.030). These cost differences expanded over time, reaching -$13,870 (95% CI: -$18,109 -$9,631; p<0.001) in months 7-12, -$11,606 (95% CI: -$19,171, -$4,042; p=0.003) in months 13-18, and -$13,575 (95% CI: -$27,810, $661; p=0.062) in months 19-24. RCC-related costs followed similar trends, with lower drug costs for N+I as the main driver of savings, while medical service costs remained consistent between groups.
CONCLUSIONS: N+I is a first-line treatment option for aRCC that offers long-term healthcare-related cost-savings and sustainable economic value, largely driven by drug cost differences. Further research with a larger sample and longer follow-up is warranted.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE64
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology