Real-World Clinical and Economic Outcomes in Selected Immune-Related Adverse Events Among Patients with Cancer Receiving Immune Checkpoint Inhibitors

Abstract

Background. With increased use of immune checkpoint inhibitors (ICIs) among cancer patients, there is substantial interest in understanding clinical, economics outcomes and management of immune-related adverse events (irAEs). Patients and Methods. A retrospective study was conducted using Premier Healthcare Database, a US national hospital discharge database, from March 1, 2015 through December 31, 2017. The database comprises more than 880 million inpatient and hospital-based outpatient encounters with more than 200 million unique patients reported by 966 hospitals. Patients with four solid tumors known to benefit from ICI therapy were included. The list of irAEs assessed were defined a priori per ASCO clinical guidelines for irAE management. Baseline irAE-related inpatient and outpatient visits were defined as the first inpatient or hospita-based outpatient visit with discharge diagnosis of any irAE of interest following confirmed ICI usage within 90 days prior to the baseline visit. Patients were followed for 90 days post baseline irAE-related inpatient discharge date or outpatient visit date to assess irAE-related inpatient admissions, all-cause inhospital mortality, ICI re-initiation, and to determine costs and healthcare resource utilization.

Severe thyrotoxicosis induced by tislelizumab: a case report and literature review

“…Potential risk factors for thyroid dysfunction caused by ICIs include the presence of antithyroid antibodies at baseline, higher TSH values at baseline, and dose, duration, sex, and higher BMI values in patients receiving anti-PD-1 antibody therapy, which may be associated with a high-risk of thyroid dysfunction ( 31 , 35 ). In addition, thyroid autoantibodies may play a role in thyroid dysfunction associated with ICIs ( 36 ). Maekura et al.…”

Monitoring Endocrine Complications of Immunotherapy: A Screening Tool

“…If untreated, they lead to increased hospitalizations for management of these adverse events [ 21 ]. It has been shown that the patients requiring inpatient admission for management of irAEs have significantly higher percentage of readmission, all-cause in-hospital mortality, length of stay, and lower retention of ICI therapy [ 22 ]. This contributes significantly to healthcare-related costs.…”

“…The average total cost of medical care after a diagnosis of hypophysitis is estimated to be $16,465 whereas the average cost associated with diabetes, thyroid dysfunction, and adrenal insufficiency is $9,453, $9,399, and $3,974, respectively. The overall mean (±SD) cost was $29,477 (± $48,087) for patients with an inpatient baseline irAE-related visit and $5,718 (± $13,720) for patients with a baseline irAE-related outpatient visit [ 22 ].…”

Role-Specific Curricular Needs for Identification and Management of Immune-Related Adverse Events

“…While oncologists, rheumatologists, and other specialists treat irAEs in outpatient clinics, some oncology clinicians and hospitalists have roles in identification and management of irAEs in inpatient settings. Additionally, irAEs that require inpatient treatment are typically of higher grade and have a higher cost burden on the healthcare system [5,6].…”