Clinical Outcomes, Costs, and Healthcare Resource Utilization in Patients with Metastatic Merkel Cell Carcinoma Treated with Immune Checkpoint Inhibitors vs Chemotherapy
Authors Zheng Y, Yu T, Mackey RH, Gayle JA, Wassel CL, Phatak H, Kim R
Received 7 November 2020
Accepted for publication 23 February 2021
Published 23 March 2021 Volume 2021:13 Pages 213—226
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Giorgio Lorenzo Colombo
Ying Zheng,1 Ting Yu,2 Rachel H Mackey,3,4 Julie A Gayle,3 Christina L Wassel,3 Hemant Phatak,1 Ruth Kim5
1 EMD Serono, Inc., Rockland, USA; An Affiliate of Merck KGaA, Darmstadt, Germany; 2Global Medical Affairs, EMD Serono, Inc., Rockland, MA, USA; An Affiliate of Merck KGaA, Darmstadt, Germany; 3Premier Applied Sciences, Premier, Inc, Charlotte, NC, USA; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; 5Pfizer Inc., New York, NY, USA
Correspondence: Ruth Kim
Pfizer Inc., New York, NY 10017, USA
Tel +1 212 733-7637
Email [email protected]
Purpose: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with poor prognosis. This study compared patient characteristics, comorbidities, adverse events (AEs), treatment persistence, healthcare resource utilization (HRU) and costs in patients with metastatic MCC (mMCC) treated with immune checkpoint inhibitors (ICIs) or recommended chemotherapy per 2018 National Comprehensive Cancer Network (NCCN) Guidelines.
Patients and Methods: A retrospective, observational study was conducted using data from 3/1/2015 through 12/31/2017 from the Premier Healthcare Database, a US hospital discharge database. The study included patients aged ≥ 12 years with International Classification of Diseases Codes for MCC and metastasis, categorized by their first treatment (index) during the study period (ICI or NCCN-recommended chemotherapy [chemotherapy]). Patient, hospital, and visit characteristics were assessed at the index date and Charlson Comorbidity Index (CCI) score and comorbidities during a 6-month look-back period. Clinical outcomes, including AEs and treatment persistence were assessed over 90 days and HRU and costs over 180 days post-index.
Results: Of 75 patients with mMCC receiving ICIs (n=37) or chemotherapy (n=38), mean age was ≈73 years, and 21.3% had a history of immune-related (IR) conditions. Overall, ICI- and chemotherapy-treated patients were similar in most baseline characteristics, IR comorbidities, and CCI score. However, more ICI patients (46%) than chemotherapy patients (26%) persisted on treatment over 90-day follow-up, odds ratio (95% CI): 2.04 (0.93, 4.47), P=0.07. Over 180-day follow-up, 33% of patients had an inpatient admission with mean length of stay (LOS) ≈2 days shorter for ICI vs chemotherapy (not statistically significant). Total costs, primarily driven by pharmacy costs, were higher for ICIs than chemotherapy; other departmental costs were similar between treatment groups.
Conclusion: In a real-world setting, patients with mMCC receiving ICIs had higher treatment persistence over 90 days, shorter inpatient LOS and similar departmental cost (excluding pharmacy cost) than those receiving chemotherapy.
Keywords: metastatic Merkel cell carcinoma, immune checkpoint inhibitors, chemotherapy
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