Healthcare use lower with pembrolizumab-axitinib than with ipilimumab-nivolumab

According to research presented at IKCS North America 2022, patients receiving first-line pembrolizumab plus axitinib for metastatic renal cell carcinoma (mRCC) have lower health care resource use (HCRU) than patients receiving first-line ipilimumab plus nivolumab.

To examine the use of these therapies in a real-world setting, researchers analyzed 507 patients from the Optum Research Database who had a first claim associated with an mRCC diagnosis between July 2017 and August 2020.

Patients received pembrolizumab plus axitinib (n=126) or ipilimumab plus nivolumab (n=381) as first-line treatment. The mean age was 67.93 years in the pembrolizumab-axitinib group and 66.52 years in the ipilimumab-nivolumab group. Most patients in both groups were male (72.22% and 71.13%, respectively).

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More than half of the patients had lung metastasis – 55.56% in the pembrolizumab-axitinib group and 54.33% in the ipilimumab-nivolumab group. Patients also had bone metastasis (32.54% and 33.60%), respectively, lymph node metastasis (25.40% and 27.82%), and liver metastasis (11.90% and 16.54%).

During the first 90 days of treatment, pembrolizumab-axitinib recipients had a lower HCRU than ipilimumab-nivolumab recipients. This included:

  • Fewer hospital admissions (mean 0.09 and 0.23, respectively; p <.001)
  • Shorter hospital stays (mean 0.80 days vs 2.24 days; p <.001)
  • Fewer hospital admissions during intensive care visits (mean 0.05 vs 0.10; p =.015)
  • Fewer outpatient visits (mean 6.68 vs 7.52; p =.029).

Medical costs were lower in the first 90 days in the pembrolizumab-axitinib group than in the ipilimumab-nivolumab group (mean $21,123 and $48,436, respectively; p <.001). However, pharmacy costs in the first 90 days were higher in the pembrolizumab-axitinib group (mean $15,840 versus $502; p <.001).

Overall, pembrolizumab-axitinib was associated with lower total cost of care in the first 90 days than ipilimumab-nivolumab (mean $36,963 vs. $48,939; p <.001).

The researchers also looked at HCRU throughout the follow-up period. The median follow-up was 8.72 months for the pembrolizumab-axitinib group and 10.77 months for the ipilimumab-nivolumab group.

During the follow-up period, patients in the pembrolizumab-axitinib group had significantly fewer clinical stays (p <.001), shorter hospital stays (p <.001), and fewer hospitalizations with intensive care visits (p =.013). However, there was no significant difference between the groups for outpatient visits.

Medical costs were lower in the pembrolizumab-axitinib group throughout the follow-up period (p <0.001) and pharmacy costs were higher across the period in the pembrolizumab-axitinib group (p <.001). There was no significant difference between the groups for total health care costs.

These data indicate that pembrolizumab-axitinib is associated with lower HCRU and costs, but prospective studies are needed to confirm these findings, the researchers concluded.

Disclosures: Some of the study authors are employed by Optum and Merck Sharp & Dohme LLC.


Shah NJ, Shinde R, Moore KJ, et al. Healthcare resource utilization (HCRU) and costs in patients with metastatic renal cell carcinoma (mRCC) receiving first-line (LOT1) pembrolizumab + axitinib (P+A) or ipilimumab + nivolumab (I+N) to get. Presented at IKCS North America 2022. November 4-5, 2022. Summary 22.

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