Hospitalization at home use analysis for immune checkpoint inhibitors administrations in France: Care pathways, costs...

The number of patients treated with immune checkpoint inhibitors (ICIs) has increased over time. Hospital-at-home (HAH) administration has been described in international studies as a model that may enhance patients' quality of life and relieve hospital capacity. The extent to which it has been adopted in France remains unknown. This study aimed to describe HAH use for ICI administration in France in 2021-2022, characterize care pathways, and assess reimbursed costs using national claims data.

Using French national hospital databases, this retrospective observational study identified all patients with at least one ICI administration in 2021-2022 with retrospective follow-up of ICI administration stays since 2016.

Between 2021-2022, 106,689 patients received ICIs, mostly in conventional hospital settings (99.4% in day care units (DCU)). Among them, < 1% benefited from HAH: 330 lung cancer patients (0.6% of all lung cancer patients, n=56,386), 42 adjuvant melanoma patients (1.3%, n=3141), and 69 metastatic melanoma patients (1.0%, n=6589). Among HAH patients, the mean duration between the first ICI administration in conventional hospitalization and initiation in HAH was 10.1 months (± 13.3). From first to last HAH administration, 195 patients (59.1%) received all administrations in HAH, whereas others alternated with DCU care. The median cost per HAH administration was €262 (IQR: 226-317) with variations across indications and regions.

In 2021-2022, HAH administration of ICIs remained very limited with heterogeneous care pathways depending on organizational and patient-level factors. This study highlights the potential for development of HAH, but additional research is needed to identify key drivers.