Utilization of Immunotherapy in Patients with Cancer Treated in Routine Care Settings: A Population-Based Study Using Health Administrative Data

Abstract

Introduction The introduction of immunotherapy (IO) in the treatment of patients with cancer has significantly improved clinical outcomes. Population level information on actual IO utilization is limited. Methods We conducted a retrospective cohort study using provincial health administrative data from Ontario, Canada to: (1) assess the extent of IO use from 2011 (pre-IO funding) to 2019; and (2) identify factors associated with IO use in patients with advanced cancers for which IO is reimbursed including melanoma, bladder, lung, head and neck, and kidney tumors. The datasets were linked using a unique encoded identifier. A Fine and Gray regression model with death as a competing risk was used to identify factors associated with IO use. Results Among 59 510 patients assessed, 8771 (14.7%) received IO between 2011 and 2019. Use of IO increased annually from 2011 (3.3%) to 2019 (39.2%) and was highest in melanoma (52%) and lowest in head and neck cancer (6.6%). In adjusted analysis, factors associated with lower IO use included older age (hazard ratio (HR) 0.91 (95% CI, 0.89-0.93)), female sex (HR 0.85 (95% CI, 0.81-0.89)), lower-income quintile, hospital admission (HR 0.78 (95% CI, 0.75-0.82)), high Charlson score and de novo stage 4 cancer. IO use was heterogeneous across cancer centers and regions. Conclusion IO utilization for advanced cancers rose substantially since initial approval albeit use is associated with patient characteristics and system-level factors even in a universal healthcare setting. To optimize IO utilization in routine practice, survival estimates and potential inequity in access should be further investigated and addressed.

Changes in Treatment Patterns and Costs for Lung Cancer Have Not Resulted in Relevant Improvements in Survival: A Population-Based Observational Study in Catalonia

“…However, in an observational study conducted in Canada, ICIs were rapidly adopted for different lines of treatment, especially after the drugs were approved in 2017 [ 44 ]. There, the approval of immunotherapy led to a more dramatic rise in the proportion of patients receiving these treatments for the first line, reaching around 17% in patients with advanced non-small cell lung carcinoma from 2016 to 2019 [ 45 ]. Thus, the initial uptake of immunotherapy in our context seems to have been slower than in Canada, although our analysis was not designed to identify or evaluate the speed of the adoption of immunotherapy.…”

Hybridizing mechanistic mathematical modeling with deep learning methods to predict individual cancer patient survival after immune checkpoint inhibitor therapy

“…Current ICI usage rates are approaching the estimated total population that may receive therapeutic benefit (one meta-analysis reported 39.2% in 2019) [8], but it is unlikely that all treated patients fall within the population that will receive benefit. There remains a significant unmet need for methods to identify patients likely to receive benefit from ICI on a per-patient basis.…”

Adoption of Innovative Therapies Across Oncology Practices—Evidence From Immunotherapy

“…Between 2010 and 2021, the US Food and Drug Administration (FDA) approved immunotherapy for 19 cancer types . Although existing studies have documented immunotherapy use overall and across different types of patients, little is known about how adoption varies across practice types . On one hand, logistical and cost barriers to adopting immunotherapy are small compared with many other technologies, suggesting widespread adoption is possible.…”

“…22 Although existing studies have documented immunotherapy use overall and across different types of patients, little is known about how adoption varies across practice types. 13,[23][24][25][26][27][28] On one hand, logistical and cost barriers to adopting immunotherapy are small compared with many other technologies, suggesting widespread adoption is possible. Immunotherapies are easy to administer, require no specialized equipment, and tend to have milder adverse effects than traditional chemotherapy.…”