Background
We investigated the association between adverse events (AEs) suspected to be immune‐related and healthcare resource utilization (HCRU), costs, and mortality among patients receiving PD‐1/PD‐L1 immune checkpoint inhibitor (ICI) monotherapy for urothelial carcinoma, renal cell carcinoma, non‐small cell lung cancer, or Merkel cell carcinoma.
Patients and Methods
Retrospective cohort study using medical and pharmacy claims and enrollment information from US commercial and Medicare Advantage with Part D enrollees in the Optum Research Database from March 1, 2014, through April 30, 2019. Claims were linked with mortality data from the Social Security Death Index and the National Death Index. Eligible patients had ≥1 ICI claim between September 1, 2014 and April 30, 2019.
Results
After adjusting for potential confounding variables, we found patients with AEs had more than double the risk of an inpatient stay (HR, 2.2; 95% CI = 1.9–2.5) and an 80% higher risk of an emergency visit (HR, 1.8; 1.6–2.1) than patients without AEs. Adjusted 6‐month total costs were $24,301 higher among patients with an AE versus those without ($99,037 versus $74,736, 95% CI = $18,828–$29,774, p < .001). Mean AE‐related medical costs averaged $2359 (SD, $7496) per patient per month, driven by inpatient visits which accounted for 89.9% of AE‐related costs. Adjusted risk of mortality was similar in patients with and without AEs.
Conclusions
Patients with AEs had higher risks of hospitalizations, ER visits, and higher healthcare costs, driven by inpatient stays, than patients without AEs. The adjusted risk of mortality was similar between the two cohorts.
Implications for Practice
Patients taking immune checkpoint inhibitors (ICIs) who had adverse events (AEs) had significantly higher healthcare costs and utilization, driven by inpatient stays, compared to patients who did not. Given this high cost associated with AEs and the differences in the side effect profile of ICIs versus traditional chemotherapy, it is important for physicians to be cognizant of these differences when treating patients with ICIs. Ongoing evaluation, earlier recognition and more effective, multidisciplinary management of AEs may improve patient outcomes and reduce the need for costly inpatient stays.
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The Impact of Adverse Events on Healthcare Resource Utilization, Costs, and Mortality among Patients with Immune Checkpoint Inhibitors - The Oncologist
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