The number of cancer patients using immune checkpoint inhibitor drugs has steadily risen since they hit the market in 2011, and a new report from Evernorth offers payers key strategies to manage these therapies.
These drugs, which enable a patient's own immune cells to destroy cancer, have been key in rising survival rates for melanoma, lung cancer and kidney cancer. As of 2021, 12.1% of oncology patients were taking an ICI, making for an increase of 47.5% since 2018, according to the analysis.
This growth was largely seen in increased use for treating patients with breast, colorectal and prostate cancers, Evernorth found.
The amount spent on these drugs rose from $360 million globally in 2011 to $37.3 billion in 2022, and those costs are likely to grow by 19% each year through 2030, according to the report.
“The introduction of ICIs has been a game changer in cancer treatments,” said Bhuvana Sagar, M.D., senior medical principal leading clinical innovation at Evernorth and a practicing oncologist in Houston. “When ICIs are prescribed and administered in an optimal manner, they can provide significant benefits, markedly improving survival rates in comparison to other therapies.”
The analysis was based on cost and utilization data from 47.8 million people. Evernorth's researchers also dove into data on a smaller group of patients who received pembrolizumab infusions, which is the ICI most commonly used to treat metastatic lung cancer.
The key takeaways for insurers are:
Hospital infusions cost far more
The report said that close to two-thirds of ICI treatments are administered by outpatient clinics at hospitals, where it costs $157,000 each year on average to receive care. By comparison, it costs $87,000 on average annually for a patient to receive the infusions in a doctor's office, Evernorth said.
Despite this gap in costs, infusions in hospital settings continue to be the norm. The study suggests that the large number of oncology firms scooped up by hospitals and private equity firms of late is in part to blame for the continued use of hospital outpatient clinics to administer ICI treatments.
“The cost difference is associated with a far higher drug cost for these patients,” said Urvashi Patel, Ph.D., vice president of the Evernorth Research Institute. “Our research didn’t see any differences in the number of infusions or the size of the doses. This represents an opportunity to control spending on these important treatments without affecting the quality of care.”
Genomic testing best practices may be lacking
As not every cancer patient is a fit for ICI treatment, genetic testing for the critical biomarkers is necessary to ensure they are receiving appropriate care. However, Evernorth found that this testing is not always taking place; for example, 30% of patients treated with pembrolizumab did not receive biomarker testing before treatment.
The study found that patients living in areas with significant social needs, including lower incomes and limited transportation, were less likely to have gotten tested. Less than a quarter (24%) had received prior biomarker testing.
In addition, patients who had not been tested had a greater likelihood of ending ICI therapy, with 53% of those who were not tested ending their treatment after the fifth infusion.
Evidence-based guidelines can manage costs
According to Food and Drug Administration labeling, patients should receive ICI treatment for advanced non-small cell lung cancer for 24 months or less. However, the study found that 12.2% of patients receiving pembrolizumab were treated from 24 to 30 months, and 3.5% were treated from 30 to 36 months.
Plus, 4.6% were treated beyond 36 months, according to the study.
Ensuring patients stop treatment at an appropriate time could reduce wasteful spending and avoid putting patients who are at the end of life through aggressive therapies.