■免疫肿瘤学药物改变了转移性肾细胞癌(mRCC)的治疗模式。这种疗法可以提高生存率,但可能会带来可观的医疗保健资源使用(HCRU)和相关成本。需要他们的检查。
■要比较HCRU,成本,以及接受一线派姆单抗联合阿西替尼(P+A)或伊匹单抗联合纳武单抗(I+N)治疗的患者的临床结局.
这项回顾性队列研究使用了2018年1月至2020年5月开始的接受一线P+A或I+N的mRCC患者的行政索赔数据库中的数据。数据从2021年2月到2022年7月进行了分析。
■第一行P+A或I+N。
■HCCU和前90天的费用,全程一线治疗,并评估了完整的随访期。使用Kaplan-Meier分析,治疗时间,总生存率,第一急诊(ED)就诊时间,与首次住院时间进行比较。
■在507名患者中,有126例患者接受P+A(91例男性[72.2%];平均[SD]年龄,67.93[9.66]y)和381名接受I+N的患者(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个月至不可估计]vs4.1个月[95%CI,3.07至5.30个月];P<.001)。P+A组首次ED就诊的中位时间长于I+N组(7.2个月[95%CI3.9至11.1个月]vs3.3个月[95%CI,2.6至3.9个月];P=0.005),首次住院时间(9.0个月[95%CI6.5个月至不可估计]vs5.6个月[95%CI,3.9至7.9个月];P=.02).在最初的90天,P+A组比N+I组有较低比例的ED访视(43例[34.1%]vs182例[47.8%]和住院(24例[19.1%)vs144例[37.8%];P<.001).在全面随访期间,P+A组和I+N组的平均总调整成本相似,但P+A组调整后的12个月估计总费用高于I+N组(325574美元对263803美元;P=.03)。
■在这项研究中,用P+A治疗与更长的治疗时间相关,第一次ED访问的时间,住院,而P+A组的12个月估计费用较高。这是评估与mRCC现代治疗相关的经济负担的首批临床研究之一。
UNASSIGNED: 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.
UNASSIGNED: To compare HCRU, costs, and clinical outcomes among patients receiving first-line pembrolizumab plus
axitinib (P+A) or ipilimumab plus nivolumab (I+N).
UNASSIGNED: 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.
UNASSIGNED: First-line P+A or I+N.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.