Abstract 1316P
Background
This study compared all-cause adverse event (ACAE) cost per patient of nivolumab + ipilimumab + limited chemotherapy (N+I+C) 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)-9LA 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. When comparing N+I+C vs. C within CM-9LA, grade 3/4 events for ACAEs meeting a ≥15% all-grade incidence threshold were included. For N+I+C vs. P+C and A+C, the threshold used in the comparator trial was applied to CM-9LA. Costs of C in each trial were also estimated. Non-squamous (NSQ) patients in CM-9LA 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-9LA, the mean ACAE cost per patient for N+I+C vs. C was $3,617 vs. $4,241 (difference per month: −$503). Compared to P+C and A+C, N+I+C had lower costs (Table). Rates of hematological AEs were lower for N+I+C than comparators. Costs were higher when a lower incidence threshold was applied Table: 1316P
Cost of grade 3/4 ACAEs for N+I+C vs P+C and A+C
| CM-9LA vs. KN-1891 NSQ | CM-9LA vs. KN-4071 SQ | CM-9LA vs. IM1302 NSQ | ||||||||||
| N+I+C | P+C | CCM-9LA | CKN-189 | N+I+C | P+C | CCM-9LA | CKN-407 | N+I+C | A+C | CCM-9LA | CIM130 | |
| [A] Mean cost per patient | $4,154 | $6,954 | $5,368 | $5,429 | $3,859 | $6,612 | $3,377 | $7,342 | $10,519 | $18,385 | $9,104 | $13,617 |
| Diff. | −$2,800 | −$62 | −$2,753 | −$3,966 | −$7,867 | −$4,513 | ||||||
| [B] Mean DOT, mos. | 8.7 | 7.4 | 6.0 | 5.4 | 9.9 | 6.3 | 1.8 | 4.7 | 8.7 | 8.9 | 6.0 | 3.6 |
| [A] / [B] Mean cost per mo. | $475 | $940 | $890 | $1,005 | $391 | $1,050 | $1,847 | $1,562 | $1,203 | $2,066 | $1,509 | $3,752 |
| Diff. | −$465 | −$116 | −$659 | $285 | −$863 | −$2,244 |
1. AEs with ≥15% any-grade incidence included.2. AEs with ≥10% any-grade or ≥2% grade 3/4 incidence included.3. Values may not sum due to rounding.
.Conclusions
N+I+C was associated with lower ACAE costs compared to C, P+C, and A+C.
Clinical trial identification
NCT03215706.
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
D. Stenehjem: Advisory/Consultancy: Bristol-Myers Squibb. 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.