PMID- 33955118
OWN - NLM
STAT- MEDLINE
DCOM- 20210712
LR  - 20230920
IS  - 1549-490X (Electronic)
IS  - 1083-7159 (Print)
IS  - 1083-7159 (Linking)
VI  - 26
IP  - 7
DP  - 2021 Jul
TI  - The Impact of Adverse Events on Health Care Resource Utilization, Costs, and 
      Mortality Among Patients Treated with Immune Checkpoint Inhibitors.
PG  - e1205-e1215
LID - 10.1002/onco.13812 [doi]
AB  - BACKGROUND: We investigated the association between adverse events (AEs) 
      suspected to be immune-related and health care resource utilization, costs, and 
      mortality among patients receiving programmed cell death 1/programmed cell death 
      ligand 1 immune checkpoint inhibitor (ICI) monotherapy for urothelial carcinoma, 
      renal cell carcinoma, non-small cell lung cancer, or Merkel cell carcinoma. 
      PATIENTS AND METHODS: We conducted a retrospective cohort study using medical and 
      pharmacy claims and enrollment information from U.S. commercial and Medicare 
      Advantage with Part D enrollees in the Optum Research Database from March 1, 
      2014, through April 30, 2019. Claims were linked with mortality data from the 
      Social Security Death Index and the National Death Index. Eligible patients had 
      at least one ICI claim between September 1, 2014, and April 30, 2019. RESULTS: 
      After adjusting for potential confounding variables, we found patients with AEs 
      had more than double the risk of an inpatient stay (hazard ratio [HR], 2.2; 95% 
      confidence interval [CI], 1.9-2.5) and an 80% higher risk of an emergency visit 
      (HR, 1.8; 95% CI, 1.6-2.1) than patients without AEs. Adjusted 6-month total 
      costs were $24,301 higher among patients with an AE versus those without ($99,037 
      vs. $74,736; 95% CI, $18,828-29,774; p < .001). Mean +/- SD AE-related medical 
      costs averaged $2,359 +/- $7,496 per patient per month, driven by inpatient visits, 
      which accounted for 89.9% of AE-related costs. Adjusted risk of mortality was 
      similar in patients with and without AEs. CONCLUSION: Patients with AEs had 
      higher risks of hospitalizations, emergency room visits, and higher health care 
      costs, driven by inpatient stays, than patients without AEs. The adjusted risk of 
      mortality was similar between the two cohorts. IMPLICATIONS FOR PRACTICE: 
      Patients taking immune checkpoint inhibitors (ICIs) who had adverse events (AEs) 
      had significantly higher health care costs and utilization, driven by inpatient 
      stays, compared with patients who did not. Given this high cost associated with 
      AEs and the differences in the side effect profile of ICIs versus traditional 
      chemotherapy, it is important for physicians to be cognizant of these differences 
      when treating patients with ICIs. Ongoing evaluation, earlier recognition, and 
      more effective, multidisciplinary management of AEs may improve patient outcomes 
      and reduce the need for costly inpatient stays.
CI  - (c) 2021 The Authors. The Oncologist published by Wiley Periodicals LLC on behalf 
      of AlphaMed Press.
FAU - George, Saby
AU  - George S
AUID- ORCID: 0000-0002-0444-5870
AD  - Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
FAU - Bell, Elizabeth J
AU  - Bell EJ
AD  - Optum, Eden Prairie, Minnesota, USA.
FAU - Zheng, Ying
AU  - Zheng Y
AD  - Emmanuel Merck, Darmstadt Serono, Inc., Rockland, Massachusetts, USA.
FAU - Kim, Ruth
AU  - Kim R
AD  - Pfizer Inc., New York, New York, USA.
FAU - White, John
AU  - White J
AD  - Optum, Eden Prairie, Minnesota, USA.
FAU - Devgan, Geeta
AU  - Devgan G
AD  - Pfizer Inc., New York, New York, USA.
FAU - Smith, Jodi
AU  - Smith J
AD  - Emmanuel Merck, Darmstadt Serono, Inc., Rockland, Massachusetts, USA.
FAU - Lal, Lincy S
AU  - Lal LS
AD  - Optum, Eden Prairie, Minnesota, USA.
FAU - Engel-Nitz, Nicole M
AU  - Engel-Nitz NM
AD  - Optum, Eden Prairie, Minnesota, USA.
FAU - Liu, Frank X
AU  - Liu FX
AD  - Emmanuel Merck, Darmstadt Serono, Inc., Rockland, Massachusetts, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210529
PL  - England
TA  - Oncologist
JT  - The oncologist
JID - 9607837
RN  - 0 (Immune Checkpoint Inhibitors)
SB  - IM
MH  - Aged
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy
MH  - *Carcinoma, Transitional Cell
MH  - Health Care Costs
MH  - Humans
MH  - Immune Checkpoint Inhibitors
MH  - *Lung Neoplasms/drug therapy
MH  - Medicare
MH  - Retrospective Studies
MH  - United States
MH  - *Urinary Bladder Neoplasms
PMC - PMC8265346
OTO - NOTNLM
OT  - Adverse events
OT  - Cost
OT  - Health care resource utilization
OT  - Immune checkpoint inhibitors
OT  - Survival
COIS- Disclosures of potential conflicts of interest may be found at the end of this 
      article.
EDAT- 2021/05/07 06:00
MHDA- 2021/07/13 06:00
PMCR- 2021/07/01
CRDT- 2021/05/06 07:29
PHST- 2020/11/05 00:00 [received]
PHST- 2021/04/15 00:00 [accepted]
PHST- 2021/05/07 06:00 [pubmed]
PHST- 2021/07/13 06:00 [medline]
PHST- 2021/05/06 07:29 [entrez]
PHST- 2021/07/01 00:00 [pmc-release]
AID - ONCO13812 [pii]
AID - 10.1002/onco.13812 [doi]
PST - ppublish
SO  - Oncologist. 2021 Jul;26(7):e1205-e1215. doi: 10.1002/onco.13812. Epub 2021 May 
      29.