P2 Healthcare Resource Utilization (HCRU) and Cost among Patients with Metastatic Melanoma Receiving Nivolumab + Relatlimab (NIVO+RELA) or Nivolumab + Ipilimumab (NIVO+IPI) in the Optum Database

Objectives An indirect-treatment-comparison suggested NIVO+RELA may have similar efficacy and numerically reduced treatment-related adverse event rates compared with NIVO+IPI in patients with advanced melanoma. Despite these insights, there is no claims-based cost comparison between these treatments. Therefore, this analysis aimed to compare claims-based HCRU and costs among patients with metastatic melanoma treated with first-line NIVO+RELA or NIVO+IPI in Optum’s Clinformatics Data Mart, which contains 84 million patients from all 50 US states. Methods Inclusion criteria included patients aged ≥12 years diagnosed with metastatic melanoma between March 18, 2022 (date of NIVO+RELA FDA approval), to March 31, 2024, and treated with first-line NIVO+RELA or NIVO+IPI. HCRU, calculated per patient per month (PPPM), included number of inpatient admissions, as well as outpatient, telehealth, and emergency room (ER) visits. Medical costs, calculated PPPM, included inpatient, outpatient, and ER costs. Drug costs included pharmacy- and physician-administered drugs. Separate multivariable generalized linear models compared HCRU and costs with NIVO+RELA versus NIVO+IPI and included the following covariates: age, sex, insurance type, geographical region, and Charlson Comorbidity Index. Results We identified 108 patients treated with NIVO+RELA and 239 treated with NIVO+IPI, median age 78.5 and 70.0 years, respectively. Median follow-up [range] from diagnosis was 7.8 [3.0-18.0] months for NIVO+RELA and 8.8 [3.0-23.8] months for NIVO+IPI. Compared with NIVO+IPI, NIVO+RELA was associated with 12% lower total HCRU (RR, 0.88; 95% CI, 0.79-0.98), 33% lower medical costs (RR, 0.67; 95% CI, 0.54-0.82), and 18% higher drug costs (RR, 1.18; 95% CI, 1.02-1.36). Total medical-plus-drug costs were similar (RR, 1.01; 95% CI, 0.89-1.14). Conclusions In this claims-based comparison, these dual immunotherapy regimens had similar medical-plus-drug costs, suggesting the higher drug costs with NIVO+RELA versus NIVO+IPI may be offset by fewer HCRU and medical costs with NIVO+RELA. Limitations included a short median duration of follow-up and possible patient-selection biases in treatment choice.