EC4 Real-World Healthcare Costs in Patients with Classical Hodgkin Lymphoma Treated with Pembrolizumab and Nivolumab in the United States


      Patients with classical Hodgkin lymphoma (cHL) relapsed or refractory (R/R) disease incur substantial healthcare resource utilization and costs. The PD-1 inhibitors nivolumab and pembrolizumab were approved by the FDA (May 2016 and March 2017, respectively) as treatments for R/R cHL patients; however, literature on the healthcare costs of patients treated with these two medications is sparse. This retrospective study evaluated the medical costs of patients with cHL initiated on pembrolizumab compared to nivolumab in the US.


      Healthcare insurance claims from Symphony Health’s Patient Integrated Dataverse® (07/2014-06/2018) were used to identify adult patients with cHL initiated on pembrolizumab or nivolumab (index date). Inverse probability of treatment weighting was used to adjust for differences in baseline patient characteristics between cohorts (evaluated in the 12 months prior to the index date). All-cause and cHL-related hospitalization and outpatient visit costs (based on provider charges) were reported per-patient-per-year during the observation (post-index) period. Costs were compared between cohorts using cost ratios (CR), and confidence intervals (CI) and p-values were generated using non-parametric bootstrap procedures.


      In total 92 and 218 patients were included in the pembrolizumab and nivolumab cohorts, respectively. After weighting, mean age was 55 years in both cohorts, while the proportion of females was lower in the pembrolizumab (35.3%) compared to the nivolumab cohort (44.1%). Mean Quan-Charlson comorbidity index score was well balanced (pembrolizumab: 4.2; nivolumab: 4.3). During the observation period (pembrolizumab: 295 days; nivolumab: 274 days), pembrolizumab initiators had significantly lower all-cause hospitalization costs (CR [95% CI]: 0.29 [0.06-0.76], p=0.016) and cHL-related hospitalization costs (CR [95% CI]: 0.09 [0.00-0.31], p<0.001) than nivolumab initiators. All-cause and cHL-related outpatient visit costs were not statistically different between cohorts.


      In this real-world study, adult cHL patients initiated on pembrolizumab had significantly lower all-cause and cHL-related hospitalization costs compared to patients initiated on nivolumab.