Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States

Daniel M. Geynisman, Jim C. Hu, Lei Liu, Ya Chen Tina Shih*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e93-e100
JournalClinical Genitourinary Cancer
Volume13
Issue number2
DOIs
StatePublished - Apr 1 2015

Funding

Supported by a Ruth F. Kirschstein National Research Service award (NIH T32 CA 9566-24), Agency for Healthcare Research and Quality ( R01 HS018535 , R01 HS020263 ), AHRQ R01 HS 020263 , and the University of Chicago Cancer Research Foundation Women's Board . The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from the following IMS Health Incorporated information services: LifeLink Health Plan Claims Database (2001-2011), IMS Health Incorporated. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary entities. H.L. is a consultant to Celladon Corporation and Outcome Research Solutions Inc. D.M.G. has received funding from Pfizer Inc. The other authors declare that they have no conflict of interest.

Keywords

  • Antineoplastic agents
  • Drug costs
  • Oral anticancer medications
  • Renal cell carcinoma
  • Treatment patterns

ASJC Scopus subject areas

  • Oncology
  • Urology

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