Cost trends of Metastatic Renal Cell Carcinoma Therapy: the impact of oral anticancer agents and immunotherapy.

Immunotherapy (IO) and oral anticancer agents (OAA) have improved outcomes for metastatic renal cell carcinoma (mRCC) but there is a need to understand real-world costs from the perspective of payers and patients.

We used retrospective fee-for-service Medicare 100% claims data to study patients diagnosed with mRCC in 2015-2019. We identified initial treatment type and costs (the year after diagnosis) and analyzed differences in monthly and 12-month costs over time and between OAA, IO, and combination groups and the association between OOP costs and adherence.

We identified 15,407 patients with mRCC (61% male; 85% non-Hispanic white). 6,196 received OAA, IO or combination OAA/IO as initial treatment. OAA use decreased (from 31% to 11%) with a simultaneous rise in patients receiving IO (3% to 26%) or combination IO/OAA therapy (1% to 11%). Medicare payments for all patients with mRCC increased by 41%, from $60,320 (95% CI: 58,260-62,380) in 2015 to $85,130 (95% CI: 82,630-87,630) in 2019. Payments increased in patients who received OAA, IO or combination OAA/IO but were stable in those with other/no treatment. Initial higher OOP responsibility ($200-$1000) was associated with 13% decrease in percent days covered in patients receiving OAA in the first 90 days of treatment, compared to those whose OOP responsibility was <$200.

From 2015-2019, costs for Medicare patients with mRCC rose substantially due to more patients receiving IO or IO/OAA combined therapy and increases in costs among those receiving those therapies. Increased OOP costs was associated with decreased adherence.

JNCI cancer spectrum. 2024 Aug 12 [Epub ahead of print]

Rebecca Forman, Jessica B Long, Sarah J Westvold, Khushi Agnish, Hannah D McManus, Michael S Leapman, Michael E Hurwitz, Lisa P Spees, Stephanie B Wheeler, Cary P Gross, Michaela A Dinan

Section of Medical Oncology, Internal Medicine Department, Yale School of Medicine, New Haven, CT, USA., Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT, USA., Yale School of Medicine, New Haven, CT, USA., Department of Medicine, Duke University School of Medicine, Durham, NC, USA., Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA.