Hospitalization and emergency department utilization in patients with advanced melanoma receiving pembrolizumab versus ipilimumab plus nivolumab in US academic centers

Abstract

Background: Both pembrolizumab (PEMBRO) and ipilimumab + nivolumab (IPI + NIVO) are FDA-approved immunotherapy regimens for advanced melanoma (AM). Each regimen has different toxicity profiles potentially impacting healthcare resource utilization (HCRU). This study compared real-world hospitalization and emergency department (ED) utilization within 12 months of therapy initiation of each regimen.

Methods: A retrospective cohort study was conducted in AM patients ≥18 years old initiating PEMBRO or IPI + NIVO between January 1, 2016–December 30, 2017. Patients were identified from 12 US-based academic and satellite centers. All-cause hospitalization ED visits were identified. These events were used to calculate rates per 1,000 patient months. Utilization between groups was compared using multivariate logistic regression.

Results: In total, 400 patients were included (200 PEMBRO, 200 IPI + NIVO). PEMBRO vs IPI + NIVO patients had poorer Eastern Cooperative Group (ECOG) performance status, 29% 2–4, vs 12% (p < .001); more diabetes, 21% vs 13% (p = .045); were more often PD-L1 expression positive, 77% vs 63% (p = .011); and less likely BRAF mutant, 35% vs 50% (p = .003). The proportion with more than one hospitalization over 12 months was 17% PEMBRO vs 24% IPI + NIVO. Less than 2% had more than one admission and none had more than two. Unadjusted mean (SD) hospitalizations per 1,000 patient-months were 16 (37) and 20 (38), PEMBRO and IPI + NIVO, respectively. Adjusted odds ratio for hospitalization was 0.6 (95% CI = 0.3–0.9; p = .027) for PEMBRO vs IPI + NIVO. ED visits occurred in 18% vs 21%, PEMBRO and IPI + NIVO, respectively, 0.7 (p = .186).

Conclusions: PEMBRO patients had a significantly lower probability of hospitalization through 12 months vs IPI + NIVO. The probability of ED visits did not differ.

Keywords:

• Melanoma
• immunotherapy
• healthcare resource utilization
• PD-L1 inhibitors
• real-world outcomes

JEL CLASSIFICATION CODES:

• I19
• I10

Transparency

Declaration of funding

This study was funded by Merck & Company.

Declaration of financial/other relationships

Shillington and Harshaw are employees of EPI-Q Inc. Shillington is a shareholder of EPI-Q Inc. Liu, Diede, and Scherre are employees and shareholders of Merck and Company. Lee is a consultant to Merck & Company. Macahilig and Dave are employees of Medical Data Analytics. Joseph has been an advisor to Merck & Company, Bristol-Myers Squibb, Exelixis, Incyte, Insys, Merck, and Novartis. Lee is a consultant to Merck & Company.

The peer reviewers on this manuscript have received an honorarium from JME for their review work. In addition, a reviewer on this manuscript has disclosed that they have received research, speaking and/or consulting support from companies including Galderma, GSK/Stiefel, Almirall, Alvotech, Leo Pharma, BMS, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Ortho Dermatology, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and National Psoriasis Foundation. They also consult for others through Guidepoint Global, Gerson Lehrman, and other consulting organizations. They are a founder and majority owner of www.DrScore.com. They are a founder and part owner of Causa Research. Another reviewer has disclosed that they participate as an investigator in different melanoma trials using PEMBRO and IPI + NIVO. The reviewers have no other relevant financial relationships or otherwise to disclose.

Acknowledgements

None reported.