Real-world patients with metastatic non-small cell lung cancer (NSCLC) who receive first-line immunotherapy are less likely to incur adverse event-related costs than those treated with first-line cytotoxic chemotherapy, according to recent findings.
While immunotherapies and cytotoxic chemotherapies used to treat metastatic NSCLC are associated with improved survival, they also carry a substantial risk of adverse events. Real-world data on the adverse event incidence and adverse event-related costs of current metastatic NSCLC treatments are limited.
Nicole M Engel-Nitz, PhD, Optum (Eden Prairie, MN), and colleagues sought to better understand the adverse event incidence and costs among patients initiating non-driver mutation-targeted first-line therapy for metastatic NSCLC in clinical practice. The retrospective administrative claims study included 8818 patients who received cytotoxic chemotherapy, 482 patients who received immuno-oncology agents, and 412 patients who received immunotherapy plus cytotoxic chemotherapy.
All patients were commercial or Medicare Advantage health plan members, initiated therapy between January 2008 and February 2018, and were observed from the start of first-line therapy through the earliest of health plan disenrollment, death, or March 31, 2018. Adverse event incidence rates and associated health care costs were measured from the index date through the earliest of the start of a new therapy, 180 days after the end of first-line therapy, or the end of the study period.
Results of the analysis were published in the Journal of Managed Care & Specialty Pharmacy (June 2020;26[6]:729-740).
Dr Engel-Nitz and colleagues found that 74.4% of the total patient sample had at least one adverse event during the follow-up period, though the incidence rate was lowest for the immuno-oncology cohort. Incidence rate ratios were 1.4 for both the cytotoxic chemotherapy and immunotherapy plus cytotoxic chemotherapy cohorts.
Mean adverse event-related costs were lowest in the immuno-oncology cohort ($16,319) and highest in the cytotoxic chemotherapy cohort ($23,009). A multivariable analysis showed that the odds of incurring any adverse event costs were similar for the immuno-oncology and immunotherapy plus cytotoxic chemotherapy cohorts compared with the cytotoxic chemotherapy cohort (OR, 0.82; P = .135, and OR, 0.98; P = .888, respectively).
Furthermore, researchers reported that among patients who incurred adverse event costs, those in the immuno-oncology cohort were less likely that those in the cytotoxic chemotherapy cohort to have high costs. However, they acknowledged that the difference between the immuno-oncology plus cytotoxic chemotherapy and cytotoxic chemotherapy cohorts was not statistically significant.
“These findings indicate that immuno-oncology-related adverse events are not a differentiating factor in cost of care for patients receiving first-line treatment for metastatic NSCLC in clinical practice,” authors of the study concluded.—Zachary Bessette
