Cost of adverse events (AEs) with second-line (2L) immuno-oncology agents (IO) and chemotherapy (CHEMO) in advanced non-small cell lung cancer (aNSCLC) in the real-world

Abstract

Background: Randomized clinical trials in aNSCLC demonstrated that 2L IO prolonged overall survival and lowered AE rates compared with 2L CHEMO. However, real-world (RW) evidence from clinical practice is limited, and the potential cost benefits of lower AE rates have not been examined. Here, we report average costs per patient (pt) associated with grade 3-4 AEs during 2L treatment with IO and CHEMO in aNSCLC from a US payer perspective. Methods: AEs in pts treated with 2L IO or CHEMO for aNSCLC (Mar 2015-Dec 2017) were abstracted from US electronic health records in COTA's database. Hospitalization costs for each ICD-10 code associated with the management of a grade 3-4 AE during treatment were estimated using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample 2017 dataset. Results: Of 596 pts in the analysis, 276 received IO (199 nivolumab) and 320 received CHEMO. The proportion of IO-vs CHEMO-treated pts was higher for pts aged <75 years (79% vs 71%), men (54% vs 47%), and current/former smokers (92% vs 83%); proportions in the IO and CHEMO groups were similar for non-squamous histology (84% vs 83%) and history of brain metastases (37% vs 37%). Overall, 40 (14.5%) IOtreated pts and 68 (21.3%) CHEMO-treated pts had grade 3-4 AEs, resulting in average costs per pt of $9,421 and $15,677, respectively. The main cost and event drivers in both treatment groups were alanine aminotransferase elevation (IO: 36% of total costs [32% of grade 3-4 AEs], CHEMO: 25% [21%]) and leukocytosis, indicative of infection (IO: 22% [28%], CHEMO: 33% [41%]). Table shows average cost per pt in selected subgroups. Conclusion: In thisRWanalysis in pts with aNSCLC, 2L IO was associated with lower costs for the management of grade 3-4 AEs than 2L CHEMO.