Toxicity Costs Among Patients With Melanoma Receiving Ipilimumab and Nivolumab

Costs associated with adverse events among patients with metastatic melanoma were small, encompassing 3% of total costs, according to a study presented at the virtual 2021 ASCO Annual Meeting.

“The combination of ipilimumab and nivolumab in metastatic melanoma patients increases response rates and survival outcomes,” wrote Bianca Gautron Moura, MD, Department of Oncology, University of Lausanne, Switzerland, and colleagues.

“As checkpoint inhibitors bear a significant financial impact on the health care system, we performed a study that addresses the global costs of the treatment, focusing on immune-related adverse event management costs,” they continued.

This study evaluated the frequency of immune-related adverse events, the duration, management, and outcomes in 62 patients with metastatic melanoma who were treated with ipilimumab and nivolumab at the Oncology Department of Lausanne University Hospital patients between June 1, 2016 and August 31, 2019. The hospital’s electronic health record and billing data were used to analyze melanoma-specific costs. 

The median follow-up was 32 months, with 87% of patients presenting at least one immune-related adverse event, 35% presenting a grade 3 immune-related adverse event, and one death from an immune-related adverse event. Common immune-related adverse events included diarrhea (37% any grade; 13% grade 3-4), hepatitis (36% any grade;15% grade 3-4) and skin rash (34% any grade; 10% grade 3-4).

The overall response rate was 47%, with 24% of complete response and 23% of partial response. Among the complete response group, 87% presented a grade 3-4 toxicity, and in the overall responders group, 71% presented a grade 3-4 toxicity. Patients without toxicity had no responses. Only 54% of patients with toxicity had a response, while 65% of those with a grade 3-4 toxicity had a response.

Toxicity costs averaged 3% of total expenses per patient. Medication costs and disease costs were significant contributions, at 44% and 39%, respectively.

The complete response group experienced the lowest global cost per week, at $2860 USD. Costs per week were $12,266 USD among patients presenting no toxicity, $11,603 among those presenting grade 1 toxicity, $4039 for grade 4, and $3524 for grade 3.

Patients presenting no toxicity or less severe toxicity grades were associated with higher median costs per week.

“The cost of toxicities was unexpectedly small (only 3%) compared to the total costs, especially medication costs (44%),” wrote Dr Moura and colleagues, concluding, “Also, patients with a higher degree of toxicity had lower costs and better outcomes.”—Marta Rybczynski