TY - JOUR
T1 - Hospitalization and emergency department utilization in patients with advanced melanoma receiving pembrolizumab versus ipilimumab plus nivolumab in US academic centers
AU - Joseph, Richard W.
AU - Shillington, Alicia C.
AU - Lee, Todd A.
AU - Macahilig, Cynthia P.
AU - Diede, Scott J.
AU - Dave, Vaidehi
AU - Harshaw, Qing
AU - Scherrer, Emilie
AU - Liu, Frank Xiaoqing
N1 - Publisher Copyright:
© 2019, © 2019 Merck and Company. Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
KW - Melanoma
KW - PD-L1 inhibitors
KW - healthcare resource utilization
KW - immunotherapy
KW - real-world outcomes
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U2 - 10.1080/13696998.2019.1696349
DO - 10.1080/13696998.2019.1696349
M3 - Article
C2 - 31750751
AN - SCOPUS:85076544742
SN - 1369-6998
VL - 23
SP - 132
EP - 138
JO - Journal of Medical Economics
JF - Journal of Medical Economics
IS - 2
ER -