Carcinoma a cellule renali metastatico: evidenze real-world da un ampio database amministrativo italiano

Abstract

Purpose:: To assess the healthcare resources’ consumption and integrated costs of patients with renal cancer and new metastasis (mRCC), in the perspective of the Italian National Health System (NHS).

Methods:: From the ReS database, through the administrative data record linkage, adults with a primary/secondary hospital (ordinary/daily admissions) diagnosis (ICD9-CM code) of renal cancer and lymph node and/or distant metastases in the same hospital discharge (index date) were selected in 2015. Metastases were defined new if they were absent in the 2 previous years. Patients were described in terms of gender, age (mean ± SD) and comorbidities of interest. The 2-year survival and annual pharmacological treatments, hospitalization, outpatient specialist services and costs were analysed.

Results:: Out of >6 million adults in the 2015 ReS database, 133 (2.1 × 100,000) were hospitalized with a diagnosis of RCC and metastasis. Patients with new metastases were 63.2% (1.4 × 100,000; 73.8% males; mean age 68 ± 13). Hypertension was the most common comorbidity (70.2% of mRCC patients). The 2-year survival of mRCC patients was 26.2%. During 1-year follow-up, at least a drug was prescribed to 88.1% of mRCC patients (on average € 12,095/patient), 91.7% were hospitalized (€ 8,897/patient) and 82.1% entrusted the outpatient specialist care (€ 1,075/patient). The mean overall expenditure for the NHS was € 22,067 per capita.

Conclusions:: This study shows the mRCC burden on the Italian real clinical practice and its economic impact in the perspective of the NHS. Real-world analyses prove to be useful to concretely estimate the overall healthcare responsibility on patients affected by mRCC.

Fig. 1 -

Selezione dei pazienti con RCC e nuova diagnosi di metastasi, dal database ReS. La Figura 1 descrive la creazione della coorte dei pazienti con carcinoma a cellule renali e nuova metastasi (mRCC), a partire dalla popolazione del database ReS per l’anno 2015.

Fig. 2 -

Probabilità di sopravvivenza (curve di Kaplan-Meier) nei due anni di osservazione nei pazienti con mRCC. La Figura 2 descrive la percentuale di pazienti con carcinoma a cellule renali e nuova metastasi (mRCC) sopravvissuti al decesso sul totale dei pazienti a rischio per ogni mese dei due anni di osservazione dopo la data indice. Le curve prodotte tramite il metodo Kaplan Meier mostrano le probabilità di sopravvivenza per la coorte totale e suddivisa per sesso.

Figura supplementare 1 -

Distribuzione percentuale della popolazione italiana nel 2015 per fasce d'età, nel database ReS e secondo I'lstituto Nazionale di Statistica (ISTAT)