Estimated Costs of the Ipilimumab-Nivolumab Therapy and Related Adverse Events in Metastatic Melanoma.

Autor: Gautron Moura B; Service of Oncology, Cantonal Hospital Fribourg (HFR), Chemin des Pensionnats 1-6, 1700 Fribourg, Switzerland., Gerard CL; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland., Testart N; Department of Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland., Caikovski M; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland., Wicky A; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland., Aedo-Lopez V; Department of Oncology, Monash Medical Centre, 823-865 Centre Road, East Bentleigh, Melbourne, VIC 3165, Australia., Berthod G; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland.; Service of Oncology, Valais Hospital (CHVR), Avenue Grand Champsec 80, 1951 Sion, Switzerland., Homicsko K; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland., Prior JO; Department of Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland., Dromain C; Department of Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland., Kandalaft LE; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland., Cuendet MA; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland.; Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Av., New York, NY 10065, USA.; Swiss Institute of Bioinformatics, UNIL Sorge, 1015 Lausanne, Switzerland., Michielin O; Department of Oncology, Lausanne University Hospital and Agora Translational Cancer Research Center, Rue du Bugnon, 1011 Lausanne, Switzerland.; Swiss Institute of Bioinformatics, UNIL Sorge, 1015 Lausanne, Switzerland.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2022 Dec 21; Vol. 15 (1). Date of Electronic Publication: 2022 Dec 21.
DOI: 10.3390/cancers15010031
Abstrakt: Combined ipilimumab and nivolumab significantly improve outcomes in metastatic melanoma patients but bear an important financial impact on the healthcare system. Here, we analyze the treatment costs, focusing on irAE. We conducted a retrospective analysis of 62 melanoma patients treated with ipilimumab-nivolumab at the Lausanne University Hospital between 1 June 2016 and 31 August 2019. The frequency of irAEs and outcomes were evaluated. All melanoma-specific costs were analyzed from the first ipilimumab-nivolumab dose until the therapy given subsequently or death. A total of 54/62 (87%) patients presented at least one irAE, and 31/62 (50%) presented a grade 3-4 irAE. The majority of patients who had a complete response 12/14 (86%) and 21/28 (75%) of overall responders presented a grade 3-4 toxicity, and there were no responses in patients without toxicity. Toxicity costs represented only 3% of the total expenses per patient. The most significant contributions were medication costs (44%) and disease costs (39%), mainly disease-related hospitalization costs, not toxicity-related. Patients with a complete response had the lowest global median cost per week of follow up (EUR 2425) and patients who had progressive disease (PD), the highest one (EUR 8325). Except for one patient who had a Grade 5 toxicity (EUR 6043/week), we observe that less severe toxicity grades (EUR 9383/week for Grade 1), or even the absence of toxicity (EUR 9922/week), are associated with higher median costs per week (vs. EUR 3266/week for Grade 4 and EUR 2850/week for Grade 3). The cost of toxicities was unexpectedly low compared to the total costs, especially medication costs. Patients with higher toxicity grades had better outcomes and lower total costs due to treatment discontinuation.
Databáze: MEDLINE
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