BACKGROUND: To evaluate the evolution of treatment patterns and associated costs for metastatic renal cell carcinoma (mRCC) in the United States.
MATERIALS AND METHODS: The LifeLink Health Plan Claims Database was used to create a cohort of mRCC patients with at least 12 months of continuous enrollment from 2004 to 2011. We summarized treatment patterns over time; we used a nonparametric bootstrapping method to compare costs and logistic regression to examine the association between the likelihood of advancing to third-line therapy and beyond and the number of targeted therapy agents available.
RESULTS: A total of 1527 mRCC patients were analyzed. In 2010, nine unique treatment regimens were used for first-line treatment, 8 for second-line treatment, and 8 for third-line treatment. A significant association (odds ratio 1.26; P = .001) between the odds of advancing to third-line therapy or beyond and the number of targeted agents available was noted. For 767 patients receiving modern therapy who were < 65 years old, and stratifying by whether the first-line treatment was oral or intravenous, drug cost per patient with ancillary services was $59,664 versus $86,518, respectively (P = .001). Total costs and drug out-of-pocket costs per patient during the first year increased by the number of switches: $111,680 to $2355 for no switches, $149,994 to $2538 for 1 switch, and $196,706 to $3524 for 2 or more switches. In 2004, the median drug cost was $11,458, while by 2010 it rose to $68,660.
CONCLUSION: A marked shift in the management of mRCC has occurred, with wide heterogeneity in treatment patterns. More patients are able to receive more lines of therapy, but treatment costs are high.
Written by:
Geynisman DM, Hu JC, Liu L, Tina Shih YC. Are you the author?
Department of Medical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA; Department of Urology, UCLA Medical Center, Los Angeles, CA; Department of Preventive Medicine, Northwestern University, Chicago, IL; Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL.
Reference: Clin Genitourin Cancer. 2015 Apr;13(2):e93-e100.
doi: 10.1016/j.clgc.2014.08.013
PubMed Abstract
PMID: 25450038