A time series analysis of immune checkpoint inhibitor use in the United States Medicare population: 2014–2019

Abstract

Background

The adoption of immune checkpoint inhibitors (ICIs) has dramatically transformed the treatment of numerous cancers. Medicare is the largest payer in the US and pays for physician-administered drugs through its medical Part B benefit. The aim of this study was to describe trends in ICI utilization and corresponding government expenditures within the US Medicare population.

Methods

We analyzed Medicare data to describe trends in total number of claims, total annual expenditures, expenditures per patient, and expenditures per claim for ICIs from January 2014 to December 2019.

Results

From 2014 to 2019, utilization rates for each of the seven market approved ICIs in the US increased. Over this time period, total Medicare expenditure on ICIs increased 1916% from $285,506,498 to $5,755,319,571. Concurrently, overall Medicare Part B drug expenditure increased 57% from $23,679,547,748 to $37,271,080,631. Expenditures on ICIs accounted for 40% of the increase in total Medicare Part B drug spending over this time period.

Conclusions

The rapid increase in utilization of ICIs has accounted for a disproportionate share of government drug spending growth in the United States. Policymakers can potentially curb spending growth by linking payments to patient outcomes.

Keywords:

• Immunotherapy
• immune checkpoint inhibitors
• Medicare
• cost-effectiveness
• value-based payment

Disclosure statement

Data access and responsibility: Pranav Puri had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Pranav Puri and Sujith Baliga take responsibility for the integrity of the work as a whole, from inception to published article.

Author contributions

Concept and design: All authors; Drafting of the manuscript: All authors; Critical revision of the manuscript for important intellectual content: All authors; Statistical Analysis: Pranav Puri.

Data availability statement

Data Available: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs/MedicarePartB