Abstract 1604P
Background
Monitoring the use of high cost drugs at a population level is becoming increasingly relevant for regional Healthcare systems in order to appropriately program the allocation of resources and conduct budget impact analyses whenever a novel drug is approved.
Methods
We planned a retrospective analysis of all prescriptions of high cost drugs to mRCC pts in the Veneto Region of Italy, years 2014-2018. Aggregated data of type of drug, line of treatment, treatment duration-TD, OS and costs were extracted from Veneto Healthcare database covering 4.9 million people. Average monthly cost of therapy was calculated dividing the cost of all drug resupplies dispensed to each patient by TD in mo of the same treatment. Managed entry agreements and clinical trials were not considered.
Results
We identified 1135 pts who started at least one line of systemic treatment for mRCC, and a total of 1665 treatments: 58% in first line, 26% second, 12% third, 4% fourth or further line. First-line pazopanib and sunitinib had a median DT of 10.5 and 9.7 mo (32.3% censored, p=0.51), and median OS of 28.6 and 26.2 mo (54.6% censored, p=0.61), respectively. Average monthly cost was estimated to be 3,583 and 2,679 euros for sunitinib and pazopanib, respectively (p<0.0001) (Table). Nivolumab and cabozantinib had a longer DT both in second line (compared to axitinib, everolimus and sorafenib (p<0.0001)) and third line (compared to everolimus or sorafenib, (p<0.0001)), although medians were not reached with all drugs (Table). Cost of second or third line treatment per patient was significantly higher for Nivolumab compared to all other drugs, p<0.0001 (Table).
Conclusions
Our pupulation-based analysis confirms that first line pazopanib and sunitinib have comparable DT and OS, although cost of sunitinib without managed entry agreements is higher. Nivolumab and cabozantinib have superior DT both in second and third line setting, with nivolumab being the most expensive drug. Table: 1604P
DT, OS and average monthly cost of drugs per patient (NR=not reached)
| Line | N | DT (mo) | p | OS (mo) | P | cost (euros) | p | |
| FIRST | PazopanibSunitinib | 344615 | 10.5 (8.7-12.9)9.7 (8.4-12.0) | 0.51 | 2.9.0 (21.7-35.3)26.8 (21.4-33.4) | 0.61 | 26793583 | <0.0001 |
| SECOND | AxitinibCabozantinibEverolimusNivolumabSorafenib | 1173412311828 | 5.9 (3.9-7.2)NR4.5 (3.1-5.0)8.7 (5.2-13.7)2.8 (1.6-3.7) | <0.0001 | 13.8 (10.8-24.6)NR12.2 (9.0-15.6)NR12.5 (5.4-19.4) | <0.0001 | 3.0442860335755593261 | <0.0001 |
| THIRD | CabozantinibEverolimusNivolumabSorafenib | 30585261 | NR3.8 (2.9-4.5)4.8 (2.8-10.0)3.0 (2.2-5.6) | <0.0001 | NR8.3 (6.9-14.3)NR8.9 (5.7-12.2) | <0.0001 | 2939360253482920 | <0.0001 |
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
IPSEN.
Disclosure
U. Basso: Advisory/Consultancy, Travel/Accommodation/Expenses, Speaker's fees: BMS; Honoraria (institution): Ipsen; Advisory/Consultancy, Speaker Bureau/Expert testimony, Speaker's fees: Novartis; Advisory/Consultancy, Travel/Accommodation/Expenses, Speaker's fees: Janssen; Advisory/Consultancy: Incyte; Advisory/Consultancy: MSD; Advisory/Consultancy, Speaker Bureau/Expert testimony, Speaker's fees: Sanofi; Speaker Bureau/Expert testimony, Speaker's fees: Astellas. A. Bortolami: Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: BMS; Speaker Bureau/Expert testimony: Ipsen; Travel/Accommodation/Expenses: Roche. V. Zagonel: Advisory/Consultancy, Speaker Bureau/Expert testimony: BMS; Advisory/Consultancy: Merck; Speaker Bureau/Expert testimony: Bayer; Speaker Bureau/Expert testimony: Roche; Speaker Bureau/Expert testimony: Astellas; Speaker Bureau/Expert testimony: Servier; Speaker Bureau/Expert testimony: Astra Zeneca; Speaker Bureau/Expert testimony: Lilly; Travel/Accommodation/Expenses: bayer; Travel/Accommodation/Expenses: Roche; Travel/Accommodation/Expenses: Servier. All other authors have declared no conflicts of interest.