Practice Behavior Changes After Approval of Durvalumab in Review of Insurance Claims

Oncology practices in the United States have changed since 2018 as durvalumab became available for patients with unresectable stage 3 non-small cell lung cancer (NSCLC), according to a study presented at the IASLC 2021 World Conference on Lung Cancer.

After the results from the PACIFIC trial on durvalumab from 2018 were published, the FDA approved durvalumab for unresectable stage 3 NSCLC, according to a press release. Dr. Jason Liu and his colleagues hoped to assess the use of maintenance durvalumab based on patient and physician characteristics among individuals with stage 3 NSCLC in the United States.

Liu analyzed open claims by using IQVIA pharmacy and medical claims data and adjudicated closed claims from IQVIA PharMetrics Plus Health Plan Claims Database. IQVIA attains pharmacy data from multiple sources, including retail, mail order, and specialty pharmacies, and covers approximately 90% of dispensed prescriptions in the United States, according to the press release.

The team found that the rate of durvalumab use was low overall in both the open and closed claims data sources. In the open claims data source, durvalumab use was higher for patients older than 65 years of age and treated in the Midwest.

Additionally, chemoradiation followed by 1 year of durvalumab is recommended for patients with unresectable stage 3 NSCLC.

Claims data were filtered by the following:

• Claims from patients with greater than or equal to 1 lung cancer diagnosis code between November 2017 to November 2020.
• Retain any metastatic or advanced codes.
• Exclude patients with small cell lung cancer.
• Limit to single primary tumor back to November 2015.
• Patients must have been 18 years of age or older, have no lung cancer surgery codes during the observation period, and received chemoradiation after the index date and prior to May 31, 2020.

The team analyzed 8071 NSCLC patient records from the open claims source, which showed that 22.2% received maintenance durvalumab. Further, distributions of baseline characteristics were similar between durvalumab and non-durvalumab patients.

Records from non-durvalumab users revealed that chemotherapy and pembrolizumab were most frequently used, with 34.9% of patients receiving no maintenance therapy. Additionally, 357 patients with NSCLC were included from the closed claims source, with 35.6% receiving maintenance durvalumab.

The researchers found that the rate of maintenance durvalumab use was low in both the open and closed claims data source, showing that there was a higher rate of no maintenance therapy and pembrolizumab than expected.

“We found that the use of durvalumab was lower but increasing the utilization of maintenance durvalumab (standard of care treatment) would likely result in improved oncologic outcomes,” Liu said in the press release. “We recommend future studies to better understand these current practice patterns in the US.”

REFERENCE

Review of Insurance Claims Show How Practice Behavior Changes After Approval of Durvalumab. IASLC. September 10, 2021. Accessed September 13, 2021. https://www.iaslc.org/iaslc-news/press-release/review-insurance-claims-show-how-practice-behavior-changes-after-approval