Hospitalization and emergency department utilization in patients with advanced melanoma receiving pembrolizumab versus ipilimumab plus nivolumab in US academic centers

Richard W. Joseph, Alicia C. Shillington, Todd A. Lee, Cynthia P. Macahilig, Scott J. Diede, Vaidehi Dave, Qing Harshaw, Emilie Scherrer, Frank Xiaoqing Liu

Research output: Contribution to journalArticle

Abstract

Background: Both pembrolizumab (PEMBRO) and ipilimumab + nivolumab (IPI + NIVO) are FDA-approved immunotherapy regimens for advanced melanoma (AM). Each regimen has different toxicity profiles potentially impacting healthcare resource utilization (HCRU). This study compared real-world hospitalization and emergency department (ED) utilization within 12 months of therapy initiation of each regimen. Methods: A retrospective cohort study was conducted in AM patients ≥18 years old initiating PEMBRO or IPI + NIVO between January 1, 2016–December 30, 2017. Patients were identified from 12 US-based academic and satellite centers. All-cause hospitalization ED visits were identified. These events were used to calculate rates per 1,000 patient months. Utilization between groups was compared using multivariate logistic regression. Results: In total, 400 patients were included (200 PEMBRO, 200 IPI + NIVO). PEMBRO vs IPI + NIVO patients had poorer Eastern Cooperative Group (ECOG) performance status, 29% 2–4, vs 12% (p <.001); more diabetes, 21% vs 13% (p =.045); were more often PD-L1 expression positive, 77% vs 63% (p =.011); and less likely BRAF mutant, 35% vs 50% (p =.003). The proportion with more than one hospitalization over 12 months was 17% PEMBRO vs 24% IPI + NIVO. Less than 2% had more than one admission and none had more than two. Unadjusted mean (SD) hospitalizations per 1,000 patient-months were 16 (37) and 20 (38), PEMBRO and IPI + NIVO, respectively. Adjusted odds ratio for hospitalization was 0.6 (95% CI = 0.3–0.9; p =.027) for PEMBRO vs IPI + NIVO. ED visits occurred in 18% vs 21%, PEMBRO and IPI + NIVO, respectively, 0.7 (p =.186). Conclusions: PEMBRO patients had a significantly lower probability of hospitalization through 12 months vs IPI + NIVO. The probability of ED visits did not differ.

Original languageEnglish (US)
Pages (from-to)132-138
Number of pages7
JournalJournal of Medical Economics
Volume23
Issue number2
DOIs
StatePublished - Feb 1 2020

Keywords

  • healthcare resource utilization
  • immunotherapy
  • Melanoma
  • PD-L1 inhibitors
  • real-world outcomes

ASJC Scopus subject areas

  • Health Policy

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