Abstract 332P
Background
Here we report real-world data on the incidence, duration, and severity of TE neutropenia, and neutropenia-related hospitalizations and discontinuations in pts receiving PAL or RIB for hormone receptor–positive (HR+) MBC from an electronic health record (EHR) dataset and administrative claims.
Methods
In this retrospective analysis in two mutually exclusive cohorts of pts, 1:1 matching of pts was performed based on age and year of index with PAL or RIB. The MarketScan claims database was used to evaluate incidence rates, hospitalizations, cost of care (including medical/prescription claims), and discontinuations related to TE neutropenia from 1 Jan 2015, to 31 Dec 2018. Data on neutropenia severity and duration were from the Optum de-identified EHR dataset. The rate ratio was calculated using a Poisson model.
Results
After matching, 152 pts from the MarketScan database and 168 from the Optum data set were included in each of the PAL and RIB cohorts. Overall, the number of pts reporting neutropenia, rate of neutropenia per person-year, total cost of care per treatment month, hospitalizations where neutropenia was observed, and rates of neutropenia by severity generally favored RIB (Table). The rate ratio for grade 3 or 4 neutropenia (ref RIB) was 1.3 (95% CI, 0.9-1.8). A higher proportion of pts receiving PAL discontinued treatment after first neutropenia diagnosis than those receiving RIB (13% vs. 4%).
Conclusions
Pts with HR+ MBC receiving PAL had a numerically higher rate of neutropenia and higher proportion of neutropenia-related hospitalizations and drug discontinuations than pts receiving RIB. Rates of grade 3 neutropenia were higher and duration of neutropenia was longer with PAL vs. RIB. Total cost of care was lower with RIB vs. PAL for pts with and without neutropenia. Table: 332P
| MarketScan | PALn= 152 | RIBn= 152 |
| Neutropenia events, n (%) | 38 (25) | 25 (16) |
| Rate of neutropenia per person-year (95% CI) | 0.52 (0.38-0.71) | 0.38 (0.26-0.57) |
| Rate ratio (reference RIB) (95% CI) | 1.36 (0.82-2.25) | |
| Neutropenia-related hospitalizations, n (%) | 8 (5.3) | 2 (1.3) |
| Median total cost of care per treatment month, 2019 USDa | ||
| Pts with neutropenia | $5354 | $5061 |
| Pts without neutropenia | $4292 | $3541 |
| Optum | PAL n=168 | RIB n=168 |
| Neutropenia severity, n (%) | ||
| Gr 1/2 | 54 (32) | 53 (32) |
| Gr 3 | 59 (35) | 44 (26) |
| Gr 4 | 6 (4) | 7 (4) |
| Kaplan-Meier duration of neutropenia, median, days | 29 | 20 |
aPharmacy costs associated with PAL or RIB are not included. Analysis was limited to the first 6 months of treatment.
Clinical trial identification
Editorial acknowledgement
Medical writing support was provided by Casey Nielsen, PhD, at MediTech Media, Ltd, funded by Novartis Pharmaceuticals Corporation.
Legal entity responsible for the study
Novartis Pharmaceuticals Corporation.
Funding
Novartis Pharmaceutical Corporation.
Disclosure
L. Schwartzberg: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Research Grant; Consultancy: Amgen; Research grant/Funding (institution), Research Grant: Glaxo-Smith Kline; Research grant/Funding (institution), Research Grant: Spectrum; Research grant/Funding (institution), Research Grant: Medivation; Research grant/Funding (institution), Non-remunerated activity/ies, Research Grant; Non-Financial Support: Bayer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Non-remunerated activity/ies, Research Grant; Consultancy; Non-Financial Support: Genentech/Roche; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Non-remunerated activity/ies, Research Grant; Consultancy; Non-Financial Support: Pfizer; Research grant/Funding (institution), Research Grant: Sanofi; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Non-remunerated activity/ies, Research Grant; Consultancy; Non-Financial Support: Bristol-Myers Squibb; Research grant/Funding (institution), Non-remunerated activity/ies, Research Grant; Non-Financial Support: Novartis; Research grant/Funding (institution), Research Grant: MedImmune; Honoraria (self), Advisory/Consultancy, Non-remunerated activity/ies, Consultancy; Non-Financial Support: Helsinn; Honoraria (self), Advisory/Consultancy, Consultancy: Nanostring; Honoraria (self), Advisory/Consultancy, Consultancy: Napo; Honoraria (self), Advisory/Consultancy, Consultancy: Taiho; Honoraria (self), Advisory/Consultancy, Consultancy: Genomic Health; Honoraria (self), Advisory/Consultancy, Consultancy: Myriad; Honoraria (self), Advisory/Consultancy, Non-remunerated activity/ies, Consultancy; Non-Financial Support: AstraZeneca; Non-remunerated activity/ies, Non-Financial Support: AbbVie; Non-remunerated activity/ies, Non-Financial Support: Merck; Non-remunerated activity/ies, Non-Financial Support: Celgene; Non-remunerated activity/ies, Non-Financial Support: Eli Lilly. H. Kanakamedala: Honoraria (self), Advisory/Consultancy, Consultancy: Novartis. A. Thuerigen: Shareholder/Stockholder/Stock options, Full/Part-time employment, Employment and Stock Ownership: Novartis. D. Chandiwana: Shareholder/Stockholder/Stock options, Full/Part-time employment, Employment and Stock Ownership: Novartis. C-L. Yu: Shareholder/Stockholder/Stock options, Full/Part-time employment, Employment and Stock Ownership: Novartis. S. Balu: Shareholder/Stockholder/Stock options, Full/Part-time employment, Employment and Stock Ownership: Novartis. S. Turner: Shareholder/Stockholder/Stock options, Full/Part-time employment, Employment and Stock Ownership: Novartis.