Side Effects From Immune Checkpoint Inhibitors May Increase Hospitalizations, Cost for Patients With Bladder, Liver, Lung or Skin Cancer

Patients with bladder, liver, non-small cell lung or skin cancer who experienced side effects after treatment with immune checkpoint inhibitors (ICI) had a higher risk of hospitalizations, emergency room visits and higher health care costs compared with patients who did not have side effects.

ICIs, which include PD-1/PD-L1, inhibitors have demonstrated durable response rates in patients with PD-L1 expression and patients in subgroups who have a poor prognostic.

Researchers evaluated the association between side effects caused by ICIs and health care costs and utilizations in 4,403 patients with bladder (417), liver (436), non-small cell lung (3,506) or skin (44) cancer using medical and pharmacy claims. Patients were mostly male, 70 years of age and had Medicare Advantage with Part D.

The results — which were published in The Oncologist —demonstrated that patients who had side effects due to ICIs had more than double the risk for an inpatient stay and were 80% more likely to have an emergency room visit.

As a result of more hospitalizations, patients who had side effects also experienced 30% higher medical costs than those with no side effects. The six-month total cost for patients who had side effects was $24,301 more than that of patients who had no side effects.

Specifically, patients with bladder, liver or non-small cell lung cancer with side effects, had six-month predicated total costs of $23,115, $25,289 and $24,254 higher compared with those who did not have side effects.

However, mortality did not differ between groups who experienced and did not experience side effects.

Although these patients experienced a high economic burden due to side effects, the study authors noted that chemotherapy still resulted in more side effects and higher costs in previous studies.

“Despite the economic burden of (side effects) among patients receiving ICI therapy, patients received chemotherapy have more (side effects) and higher costs, comparatively,” they wrote.

A limitation of this study was that it did not account for patients who had other types of insurance or were uninsured.

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