Abstract 1282P
Background
This study compared all-cause adverse event (ACAE) cost per patient of nivolumab + ipilimumab (N+I) vs. chemotherapy (C), pembrolizumab + chemotherapy (P+C), and atezolizumab + chemotherapy (A+C) as first-line therapy for Stage IV or recurrent non-small-cell lung cancer.
Methods
Grade 3/4 ACAE rates were obtained from individual patient data from the CheckMate (CM)-227 clinical trial and aggregate data from the KEYNOTE (KN)-189, KN-407, and IMpower130 (IM130) trials. Costs were obtained from the US Healthcare Cost and Utilization Project. Within CM-227, N+I was compared vs. C overall and within programmed death-ligand 1 (PD-L1) subgroups (≥1% and <1%). Grade 3/4 events for ACAEs meeting a ≥15% all-grade incidence threshold were included. For N+I vs. P+C and A+C, the threshold used in the comparator trial was applied to CM-227. Costs of C in each trial were also estimated. Non-squamous (NSQ) patients in CM-227 were compared to KN-189 and IM130; squamous (SQ) patients were compared to KN-407. Differences across trials were assessed both overall and adjusted for duration of treatment (DOT).
Results
Within CM-227, mean ACAE cost per patient for N+I vs. C was $2,013 vs. $3,236 in PD-L1 ≥1%, $2,300 vs. $4,735 in PD-L1 <1%, and $1,966 vs. $3,704 overall. Compared to P+C and A+C, N+I had lower costs (Table). Rates of hematological AEs were lower for N+I than comparators. Costs were higher when a lower incidence threshold was applied Table: 1282P
Cost of grade 3/4 ACAEs for N+I vs. P+C and A+C
| CM-227 vs. KN-1891 NSQ | CM-227 vs. KN-4071 SQ | CM-227 vs. IM1302 NSQ | ||||||||||
| N+I | P+C | CCM-227 | CKN-189 | N+I | P+C | CCM-227 | CKN-407 | N+I | A+C | CCM-227 | CIM130 | |
| [A] Mean cost per patient | $2,088 | $6,954 | $3,725 | $5,429 | $2,817 | $6,612 | $8,087 | $7,342 | $7,877 | $18,350 | $8,018 | $13,563 |
| Diff. | −$4,867 | −$1,705 | −$3,795 | $745 | −$10,473 | −$5,545 | ||||||
| [B] Mean DOT, mos. | 7.4 | 7.4 | 5.9 | 5.4 | 7.5 | 6.3 | 2.1 | 4.7 | 7.4 | 8.9 | 5.9 | 3.6 |
| [A] / [B] Mean cost per mo. | $282 | $940 | $626 | $1,005 | $375 | $1,050 | $3,937 | $1,562 | $1,062 | $2,062 | $1,348 | $3,737 |
| Diff. | −$658 | −$379 | −$675 | $2,375 | −$999 | −$2,390 |
1. AEs with ≥15% any-grade incidence included2. AEs with ≥10% any-grade or ≥2% grade 3/4 incidence included3. Values may not sum due to rounding
.Conclusions
N+I was associated with lower ACAE costs compared to C, P+C, and A+C.
Clinical trial identification
NCT02477826.
Editorial acknowledgement
Writing and editorial assistance was provided by Analysis Group, Inc., and funded by Bristol-Myers Squibb.
Legal entity responsible for the study
Bristol-Myers Squibb, Princeton, NJ, USA.
Funding
Bristol-Myers Squibb, Princeton, NJ, USA.
Disclosure
S.J. Lubinga, S. Rao: Shareholder/Stockholder/Stock options, Full/Part-time employment: Bristol-Myers Squibb. S.B. King, K.A. Betts: Research grant/Funding (institution), Travel/Accommodation/Expenses: Bristol-Myers Squibb. F. Castriota, M. Mahin, E. Orvis, S. Marathe, J. Ma: Research grant/Funding (institution): Bristol-Myers Squibb. D. Stenehjem: Advisory/Consultancy: Bristol-Myers Squibb.