Healthcare utilization was lower with pembrolizumab-axitinib than with ipilimumab-nivolumab

Patients receiving first-line pembrolizumab plus axitinib for metastatic renal cell carcinoma (mRCC) had lower healthcare resource utilization (HCRU) than patients receiving first-line ipilimumab plus nivolumab, according to research presented at IKCS North America 2022.

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 related to a diagnosis of mRCC between July 2017 and August 2020.

Patients received pembrolizumab plus axitinib (n=126) or ipilimumab plus nivolumab (n=381) as first-line therapy. 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 metastases — 55.56% in the pembrolizumab-axitinib group and 54.33% in the ipilimumab-nivolumab group. Patients also had bone metastases (32.54% and 33.60%, respectively), lymph node metastases (25.40% and 27.82%), and liver metastases (11.90% and 16.54%). .

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

  • Fewer hospital stays (mean 0.09 and 0.23, respectively; P <.001)
  • Shorter hospitalizations (mean 0.80 days vs. 2.24 days; P <.001)
  • Fewer hospital stays with ICU visits (mean 0.05 vs 0.10; P =.015)
  • Fewer outpatient visits (mean 6.68 vs 7.52; P =.029).

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

Overall, pembrolizumab-axitinib was associated with lower total healthcare costs in the first 90 days compared with ipilimumab-nivolumab ($36,963 vs $48,939; mean; P <.001).

The researchers also looked at HCRUs throughout the follow-up period. 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 hospital stays (P <.001), shorter hospitalizations (P <.001) and fewer inpatient stays with an ICU visit (P =.013). However, there was no significant difference between groups for outpatient visits.

Medical costs during the entire follow-up period were lower in the pembrolizumab-axitinib group (P <.001), and pharmacy costs over the entire period were higher in the pembrolizumab-axitinib group (P <.001). There was no significant difference between groups for total health care costs.

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

Disclosures: Some 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). Presented at IKCS North America 2022 November 4-5, 2022 Abstract 22.

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