ECONOMIC BURDEN OF IMMUNE-RELATED ADVERSE EVENTS OF IMMUNE CHECKPOINT INHIBITORS FROM PAYER PERSPECTIVE. A REAL-WORLD PATIENT-LEVEL MICRO-COSTING STUDY FROM QATAR
Author(s)
Nabil Elhadi Omar, BSc Pharm, BCOP, PharmD, PhD (C)1, Anas Hamad, MSc, PhD2, Laila Shafei, BSc, MSc3, Seif Abaza, PharmD3, Aya Alasamr, PharmD3, Farah Jibril, PharmD3, hazem Elewa4, Daoud Al-Badriyeh, PhD4.
11- Qatar University, QU Health 2- NCCCR / Hamad Medical Corporation, Doha, Qatar, 21- Drug Supply Department / Hamad Medical Corporation. 2- College of Pharmacy, Qatar University, Doha, Qatar, 3NCCCR / Hamad Medical Corporation, Doha, Qatar, 4College of Pharmacy, Qatar University, Doha, Qatar.
11- Qatar University, QU Health 2- NCCCR / Hamad Medical Corporation, Doha, Qatar, 21- Drug Supply Department / Hamad Medical Corporation. 2- College of Pharmacy, Qatar University, Doha, Qatar, 3NCCCR / Hamad Medical Corporation, Doha, Qatar, 4College of Pharmacy, Qatar University, Doha, Qatar.
OBJECTIVES: Immune checkpoint inhibitors (ICIs) improve cancer outcomes but generate immune-related adverse events (irAEs) associated with substantial healthcare resource utilization. Real-world economic evidence from Middle Eastern oncology systems remains limited. This study quantified direct medical costs of irAEs in Qatar and identified major cost drivers.
METHODS: Patient-level micro-costing was conducted using the SAFE-ICI-Q cohort (2015-2020), including 236 adults; 132 (55.9%) developed 178 irAEs across nine organ systems. Hospitalization, medication, laboratory, and procedure costs were captured. Costs were expressed in Qatari Riyal (QAR) using 2020 NCCCR tariffs and analyzed by irAEs grade, organ system, ICI class, and fatality status. Independent cost drivers were identified using Gamma generalized linear models; predictors of high cost (top-quartile expenditure) were evaluated using multivariable logistic regression.
RESULTS: Total direct irAE-attributable expenditure reached QAR 6,458,849 (~USD 1.78M). Per-event cost was markedly right-skewed (median QAR 3,012; mean QAR 37,994). Hospitalization was the principal cost driver, accounting for 95.1% of expenditure and 769 inpatient days. Per-event median cost increased 271-fold from Grade 1 (QAR 528) to Grade 5 (QAR 142,923). Severe events (Grade 3-5) represented 44% of irAEs but consumed 73.5% of expenditures. Respiratory, endocrine, hepatic, and renal irAEs accounted for 67.2% of total costs. Cost concentration was substantial: the top 10% of patients generated 54.3% of expenditures, while patients with fatal irAEs (6.8%) consumed 35.7%. Multivariable regression confirmed irAE grade, length of stay, and number of irAE categories as independent cost drivers. Maximum grade (OR 2.29 per grade, 95% CI 1.20-4.37; p=0.012) and fatal-event status (OR 5.89, 95% CI 1.28-27.1; p=0.023) were the strongest predictors of high cost.
CONCLUSIONS: irAEs impose a substantial economic burden on Qatar’s oncology system, largely driven by hospitalization. Toxicity governance should prioritize irAE stewardship and biomarker-guided risk stratification. Regional health technology assessment frameworks should incorporate downstream irAE management costs beyond ICI acquisition costs.
METHODS: Patient-level micro-costing was conducted using the SAFE-ICI-Q cohort (2015-2020), including 236 adults; 132 (55.9%) developed 178 irAEs across nine organ systems. Hospitalization, medication, laboratory, and procedure costs were captured. Costs were expressed in Qatari Riyal (QAR) using 2020 NCCCR tariffs and analyzed by irAEs grade, organ system, ICI class, and fatality status. Independent cost drivers were identified using Gamma generalized linear models; predictors of high cost (top-quartile expenditure) were evaluated using multivariable logistic regression.
RESULTS: Total direct irAE-attributable expenditure reached QAR 6,458,849 (~USD 1.78M). Per-event cost was markedly right-skewed (median QAR 3,012; mean QAR 37,994). Hospitalization was the principal cost driver, accounting for 95.1% of expenditure and 769 inpatient days. Per-event median cost increased 271-fold from Grade 1 (QAR 528) to Grade 5 (QAR 142,923). Severe events (Grade 3-5) represented 44% of irAEs but consumed 73.5% of expenditures. Respiratory, endocrine, hepatic, and renal irAEs accounted for 67.2% of total costs. Cost concentration was substantial: the top 10% of patients generated 54.3% of expenditures, while patients with fatal irAEs (6.8%) consumed 35.7%. Multivariable regression confirmed irAE grade, length of stay, and number of irAE categories as independent cost drivers. Maximum grade (OR 2.29 per grade, 95% CI 1.20-4.37; p=0.012) and fatal-event status (OR 5.89, 95% CI 1.28-27.1; p=0.023) were the strongest predictors of high cost.
CONCLUSIONS: irAEs impose a substantial economic burden on Qatar’s oncology system, largely driven by hospitalization. Toxicity governance should prioritize irAE stewardship and biomarker-guided risk stratification. Regional health technology assessment frameworks should incorporate downstream irAE management costs beyond ICI acquisition costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH186
Topic
Clinical Outcomes, Epidemiology & Public Health, Patient-Centered Research
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Oncology, Personalized & Precision Medicine