The cost of ipilimumab toxicity

Abstract

There are no published data on the costs associated with investigating and managing toxicity from ipilimumab treatment in patients with metastatic melanoma. Patients treated with ipilimumab at The Royal Marsden Hospital between 1 September 2010 and 1 April 2013 were identified. Data on demographics, investigations and survival outcomes were collected. Patients with grade 3 or higher immune-related adverse events were identified, and costs of investigating and managing toxicities in them were calculated on the basis of standard National Health Service tariffs. Out of the 110 patients, 29 experienced grade 3/4 immune-related adverse events. The total cost of investigating and managing these patients was £140,680, or a median cost of £2860 per patient. Patients experiencing grade 3/4 toxicities had 1-, 2- and 3-year survival rates of 79, 59 and 46%, compared with 24, 17 and 15% in the group that did not experience significant toxicity (P<0.0005). The most common treatment-related toxicity identified was colitis. Two patients died from complications associated with ipilimumab colitis. The cost of ipilimumab toxicity is marginal in comparison with the total treatment cost. Patients treated with ipilimumab who develop significant toxicity have a higher than expected 1-, 2- and 3-year survival.

Multicenter, real-life experience with checkpoint inhibitors and targeted therapy agents in advanced melanoma patients in Switzerland

“…autoimmune-colitis or hypophysitis) documented with ipilimumab. Consistently, and according to a retrospective-single-center English cohort of patients ( n =110) treated with ipilimumab, immune-related adverse events do not represent a significant expense in comparison with the drug cost itself 49.…”

Direct costs associated with adverse events of systemic therapies for advanced melanoma

“…One study was a Canadian cost-effectiveness modeling analysis [ 21 ] ; 3 were economic burden analyses using published literature and physician interviews or a Delphi panel (1 conducted in the United States [US] [ 16 ] and 2 with a multicountry perspective [ 7 , 22 ] ); 2 were cost analyses using US claims data [ 15 , 23 ] ; and 1 was a United Kingdom (UK) medical records review. [ 24 ]…”

“…[ 22 ] Other included studies identified AEs through clinical trial publications and other relevant clinical publications, [ 21 ] package inserts [ 15 ] (also in consultation with a clinical expert [ 23 ] ), or medical records. [ 24 ] Table 1 summarizes the design of each included study, including the treatments considered and criteria applied for selection of AEs.…”

Neuromuscular complications of immune checkpoint inhibitor therapy

“…There is some evidence to suggest that those with more severe irAEs, which represent successful activation of the immune system may have an improved therapeutic response and cancer survival. [97][98][99][100] However, moderate to severe irAEs require treatment with steroids, PLEX, or IVIG to re-establish control over the immune response. One might expect that suppressing this response with steroids would affect survival.…”