Nivolumab Plus Ipilimumab Proves Less Costly Than Rival Combo Over 2 Years in Advanced Renal Cell Carcinoma

The immunotherapy combination of nivolumab (Opdivo) and ipilimumab (Yervoy) produced a higher total cost of care in the first 6 months compared with pembrolizumab (Keytruda) and axitinib (Inlyta) in patients receiving first-line treatment for advanced or metastatic renal cell carcinoma (aRCC).

However, after the 6-month mark, total health care costs dropped for aRCC patients receiving nivolumab and ipilimumab compared with the pembrolizumab combination, making the first combination more cost-effective over a 2-year period, according to a recent study in Oncology and Therapy.

Nivolumab and Ipilimumab | Image credit: Bristol Myers Squibb

Investigators used data from Merative MarketScan Commercial and Medicare Supplemental Databases, from January 2004 through September 2021, to evaluate all-cause and RCC-related health care costs, which were assessed per patient per month (PPPM) at 6-month intervals up to 24 months.

According to the authors, total health care costs included drug costs and total medical services cost, which covered both inpatient and outpatient costs, emergency department, and other costs. RCC-related costs were identified based on diagnostic codes.

Of the 325 patients with aRCC evaluated by investigators, 219 received the nivolumab plus ipilimumab combination (nivo+ipi), while 106 received the pembrolizumab plus axitinib combination (pembro+axi). The follow-up analysis included:

• For months 7 to 12, 210 patients in the nivo+ipi group and 103 in the pembro+axi group.
• For months 13 to 18, 119 patients in the nivo+ipi group, and 48 in the pembro+axi group.
• For months 19 to 24, 81 patients in the nivo+ipi group, and 25 patients in the pembro+axi group.

Total cost of care. For months 1 to 6, PPPM unadjusted all-cause total costs were $46,348 for the nivo+ipi group and $38,097 for the pembro+axi group. For months 7 to 12, total costs were versus $26,840 vs versus $27,983, respectively; for months 13 to 18, total costs were $22,899 versus $25,137, respectively; and for months 19 to 24, total costs were $22,279 versus $27,947, respectively.

Unadjusted RCC-related costs followed a similar trend: for months 1 to 6, $44,059 for nivo+ipi vs $36,456 for pembro+axi, respectively; for months 7 to 12, $25,144 vs $26,692, respectively; for months 13 to 18, $21,645 vs $23,709; and for months 19 to 24, $20,486 versus $25,515.

Investigators noted that PPPM costs “declined more rapidly” for patients receiving nivo+ipi compared with those treated with pembro+axi, “resulting in significantly lower all-cause costs associated with nivo+ipi during months 19 to 24.”

In months 7 to 12, the difference was $10,194, with the difference in RCC-related costs being $4747; in months 19 to 24, the all-cause cost difference was $10,261 favoring nivo+ipi after adjustment.

Cost savings for nivo+ipi vs pembro+axi were driven by differences in drug costs. Investigators found that differences, after adjustment, were significantly lower in months 7 to 12, with a $5555 all cause difference and a $5689 RCC-related difference.

In months 13 to 18, the differences after adjustment favoring nivo+ipi were $7217 all-cause and $6870, RCC-related; in months 19 to 24, the differences favoring nivo+ipi were $16,682 all-cause and $16,125 RCC-related.

Investigators concluded that although real-world health care costs for first-line treatment of advanced RCC with for nivolumab plus ipilimumab were higher in the first 6 months, compared with pembrolizumab and axitinib, they rapidly declined thereafter, resulting in significantly lower costs from months 7 to 24. The study authors said they believe their findings would fill an information void needed for decision-making.

Even though immuno-oncology combinations have become common in first-line treatment of aRCC, most real-world studies have focused on clinical outcomes, not costs, the authors wrote.

“In addition to establishing the treatments’ longer-term efficacy and durability, an understanding of the long-term economic burden is important for informing the choice of [first-line] treatment for aRCC,” they wrote. “As such, the results of this study provide valuable information for treatment decision-making when considering the cost of care of patients with aRCC in the USA.”

They added, “A matching-adjusted indirect treatment comparison found that, over a lifetime horizon, nivo+ipi was associated with superior [overall survival] and [progression-free survival] as well as lower costs compared with [pembrolizumab plus axitinib] in the intermediate- and poor-risk aRCC populations.”

Reference

Du EX, Betts KA, Wang T, et al. Long-term temporal trends of real-world healthcare costs associated with nivolumab plus ipilimumab and pembrolizumab plus axitinib as first-line treatment for advanced or metastatic renal cell carcinoma. Oncol Ther. 2024. Published online August 10, 2024.doi: 10.1007/s40487-024-00297-0.