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)
Author(s)
Xiaoyan Du, MESc1, Keith A. Betts, PhD1, Travis Wang, MSc2, sydney ng, MPH1, Sarah B. Guttenplan, PhD3, Renuka Kandikatla, PhD, MBA3, Lisa Rosenblatt, MD, MPH3;
1Analysis Group, Inc., Los Angeles, CA, USA, 2Analysis Group, Inc., Boston, MA, USA, 3Bristol Myers Squibb, Princeton, NJ, USA
1Analysis Group, Inc., Los Angeles, CA, USA, 2Analysis Group, Inc., Boston, MA, USA, 3Bristol Myers Squibb, Princeton, NJ, USA
Presentation Documents
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