Memorial Sloan Kettering Cancer Center, New York, New York.
Merck and Co, Inc, Rahway, New Jersey.
JAMA Netw Open. 2024 Jul 1;7(7):e2422674. doi: 10.1001/jamanetworkopen.2024.22674.
Immuno-oncology agents have changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). Such therapies improve survival but can impose considerable health care resource use (HCRU) and associated costs, necessitating their examination.
To compare HCRU, costs, and clinical outcomes among patients receiving first-line pembrolizumab plus axitinib (P+A) or ipilimumab plus nivolumab (I+N).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from an administrative claims database on patients with mRCC receiving first-line P+A or I+N that was initiated between January 2018 and May 2020. Data were analyzed from February 2021 to July 2022.
First-line P+A or I+N.
HCRU and costs during the first 90 days, full first-line treatment, and full follow-up periods were assessed. Using Kaplan-Meier analysis, time on treatment, overall survival, time to first emergency department (ED) visit, and time to first inpatient stay were compared.
Among 507 patients, there were 126 patients receiving P+A (91 male [72.2%]; mean [SD] age, 67.93 [9.66] y) and 381 patients receiving I+N (271 male [71.1%]; mean [SD] age, 66.52 [9.94] years). The median time on treatment was longer for the P+A compared with I+N group (12.4 months [95% CI, 8.40 months to not estimable] vs 4.1 months [95% CI, 3.07 to 5.30 months]; P < .001). The median time to first ED visit was longer for the P+A than I+N group (7.2 months [95% CI 3.9 to 11.1 months ] vs 3.3 months [95% CI, 2.6 to 3.9 months]; P = .005), as was time to first inpatient stay (9.0 months [95% CI 6.5 months to not estimable] vs 5.6 months [95% CI, 3.9 to 7.9 months]; P = .02). During the first 90 days, a lower proportion of the P+A than N+I group had ED visits (43 patients [34.1%] vs 182 patients [47.8%] and inpatient stays (24 patients [19.1%) vs144 patients [37.8%]; P < .001). During full follow-up, mean total adjusted costs were similar for P+A and I+N groups, but adjusted 12-month estimated total costs were higher for P+A than I+N groups ($325 574 vs $ 263 803; P = .03).
In this study, treatment with P+A was associated with longer time on treatment, time to first ED visit, and inpatient stay, while 12-month estimated costs were higher for the P+A group. This is among the first clinical studies to evaluate economic burden associated with modern treatments for mRCC.
免疫肿瘤学药物改变了转移性肾细胞癌（mRCC）的治疗模式。这些疗法提高了生存率，但会带来相当大的医疗资源利用（HCRU）和相关成本，因此有必要对其进行评估。
比较接受一线帕博利珠单抗联合阿昔替尼（P+A）或伊匹单抗联合纳武利尤单抗（I+N）治疗的患者的 HCRU、成本和临床结局。
设计、设置和参与者：这项回顾性队列研究使用了来自一个行政索赔数据库的数据，该数据库包含了 2018 年 1 月至 2020 年 5 月期间接受一线 P+A 或 I+N 治疗的 mRCC 患者的数据。数据分析于 2022 年 2 月至 7 月进行。
一线 P+A 或 I+N。
评估了第 90 天内、整个一线治疗期间和整个随访期间的 HCRU 和成本。使用 Kaplan-Meier 分析比较了治疗时间、总生存时间、首次急诊就诊时间和首次住院时间。
在 507 名患者中，有 126 名患者接受了 P+A（91 名男性[72.2%]；平均[SD]年龄，67.93 [9.66] y）和 381 名患者接受了 I+N（271 名男性[71.1%]；平均[SD]年龄，66.52 [9.94] 年）。与 I+N 组相比，P+A 组的中位治疗时间更长（12.4 个月[95%CI，8.40 个月至无法估计]与 4.1 个月[95%CI，3.07 至 5.30 个月]；P<0.001）。与 I+N 组相比，P+A 组首次急诊就诊的中位时间更长（7.2 个月[95%CI 3.9 至 11.1 个月]与 3.3 个月[95%CI，2.6 至 3.9 个月]；P=0.005），首次住院的中位时间也更长（9.0 个月[95%CI 6.5 个月至无法估计]与 5.6 个月[95%CI，3.9 至 7.9 个月]；P=0.02）。在第 90 天内，与 I+N 组相比，P+A 组接受急诊就诊的比例较低（43 名患者[34.1%]与 182 名患者[47.8%]，接受住院治疗的比例较低（24 名患者[19.1%]与 144 名患者[37.8%]；P<0.001）。在整个随访期间，P+A 和 I+N 组的平均总调整成本相似，但 12 个月的估计总成本 P+A 组高于 I+N 组（325574 美元比 263803 美元；P=0.03）。
在这项研究中，P+A 治疗与更长的治疗时间、首次急诊就诊时间和住院时间相关，而 P+A 组的 12 个月估计成本更高。这是首批评估 mRCC 现代治疗相关经济负担的临床研究之一。
