Ghate Sameer R, Li Zhiyi, Tang Jackson, Nakasato Antonio Reis
Director, Health Economics and Outcomes Research, Novartis Oncology, East Hanover, NJ.
Partner, Asclepius Analytics, New York, NY.
Am Health Drug Benefits. 2018 Oct;11(7):334-343.
Immunotherapies and targeted therapies have drastically improved survival in metastatic melanoma, but they can cause a range of adverse events (AEs). Understanding the costs of these events would facilitate an accurate comparison of melanoma treatments.
To compare the costs and frequency of AEs associated with immunotherapy and with targeted therapy in elderly patients with metastatic melanoma.
We conducted a retrospective cohort study using Medicare claims data from 2011 to 2014. Patients included had to have ≥1 diagnoses of metastatic melanoma and ≥1 claims for an immunotherapy or targeted therapy. We compared the 30-day expenditures of patients with and without each AE using a generalized linear model to determine the incremental cost per AE in patients who received immunotherapy or targeted therapy. The baseline demographic and clinical differences were adjusted for using propensity score with inverse probability of treatment. We also compared the mean costs of AEs associated with immunotherapy and targeted therapy.
A total of 844 patients were included in the study (mean age, 75 years; standard deviation, 14 years). The mean baseline Charlson Comorbidity Index score was 8.4, and 65% of the patients were male. The mean cost for AEs was highest for respiratory events (ie, $24,150). Gastrointestinal, respiratory, and hematologic AEs were more common in patients who received immunotherapy, whereas general and administration-site AEs and other AEs (eg, fatigue, infections, muscular weakness) were more frequent in patients who received targeted therapy. AE-related costs with immunotherapy were highest for gastrointestinal, respiratory, and pain-related AEs; AEs with targeted therapy were highest for cardiovascular and general and administration-site events.
These findings suggest that incremental costs associated with treatment-related AEs among elderly patients with metastatic melanoma were substantial, but the risks for and costs of the various types of AEs differed by therapy. Understanding the risks for and costs of AEs associated with the various therapeutic options can inform treatment decision-making in elderly patients with metastatic melanoma.
免疫疗法和靶向疗法显著提高了转移性黑色素瘤患者的生存率，但它们会引发一系列不良事件（AE）。了解这些事件的成本将有助于准确比较黑色素瘤的治疗方法。
比较老年转移性黑色素瘤患者免疫疗法和靶向疗法相关不良事件的成本和发生频率。
我们使用2011年至2014年医疗保险理赔数据进行了一项回顾性队列研究。纳入的患者必须有≥1次转移性黑色素瘤诊断且有≥1次免疫疗法或靶向疗法理赔记录。我们使用广义线性模型比较了发生和未发生每种不良事件的患者的30天支出，以确定接受免疫疗法或靶向疗法患者中每种不良事件的增量成本。使用倾向得分和治疗的逆概率对基线人口统计学和临床差异进行了调整。我们还比较了免疫疗法和靶向疗法相关不良事件的平均成本。
共有８４４名患者纳入研究（平均年龄75岁；标准差14岁）。Charlson合并症指数的平均基线评分为8.4，65%的患者为男性。不良事件的平均成本以呼吸事件最高（即24,150美元）。胃肠道、呼吸和血液学不良事件在接受免疫疗法的患者中更常见，而一般和给药部位不良事件以及其他不良事件（如疲劳、感染、肌肉无力）在接受靶向疗法的患者中更频繁。免疫疗法相关的胃肠道、呼吸和疼痛相关不良事件的成本最高；靶向疗法相关的心血管、一般和给药部位不良事件的成本最高。
这些发现表明，老年转移性黑色素瘤患者与治疗相关不良事件相关的增量成本很高，但不同疗法的各种不良事件的风险和成本有所不同。了解与各种治疗选择相关的不良事件的风险和成本可以为老年转移性黑色素瘤患者的治疗决策提供参考。
