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. 2024 Sep 2;8(5):pkae067.
doi: 10.1093/jncics/pkae067.

Cost trends of metastatic renal cell carcinoma therapy: the impact of oral anticancer agents and immunotherapy

Rebecca Forman  1 , Jessica B Long  2   3 , Sarah J Westvold  2   3 , Khushi Agnish  4 , Hannah D Mcmanus  5 , Michael S Leapman  2   6 , Michael E Hurwitz  1 , Lisa P Spees  7   8 , Stephanie B Wheeler  7   8 , Cary P Gross  2   3 , Michaela A Dinan  2   9
Affiliations

Cost trends of metastatic renal cell carcinoma therapy: the impact of oral anticancer agents and immunotherapy

Rebecca Forman et al. JNCI Cancer Spectr. .

Abstract

Background: 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.

Methods: 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 Out-Of-Pocket (OOP) costs and adherence.

Results: We identified 15 407 patients with mRCC (61% male; 85% non-Hispanic White). A total of 6196 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% confidence interval = 58 260 to 62 380) in 2015 to $85 130 (95% confidence interval = 82 630 to 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 with those whose OOP responsibility was less than $200.

Conclusion: From 2015 to 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.

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Conflict of interest statement

S.B.W. reported receiving grants from Pfizer outside of the submitted work. L.P.S. reported receiving grants from AstraZeneca/Merck outside of the submitted work. M.E.H. serves on advisory boards for Bristol Myers Squibb, Nektar Therapeutics, Janssen Pharmaceuticals, Exelixis, and CRISPR Therapeutics and receives research funding outside of the submitted work from Achilles, Apexigen, Astellas, AstraZeneca, Bayer, Bristol Myer Squibb, Clovis, Corvus, Eli Lilly, Endocyte, Genentech, Genmab, GSK, Innocrin, Iovance, KSQ Therapeutics, MedImmune, Merck, Nektar Therapeutics, Novartis, Pfizer, Progenics, Roche Laboratories, Sanofi Aventis, SQZ Biotech, and Seattle Genetics. H.D.M. reports receiving grants from Pfizer outside of the submitted work. C.P.G. reports receiving grants from AstraZeneca, Genentech, and Johnson & Johnson outside of the submitted work. M.A.D. reports receiving grants from AstraZeneca outside of the submitted work. All other authors had no potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Trends in type of treatment received as first-line therapy over time. We identified the earliest treatment a person received as OAA, IO, other, or none in the first year after diagnosis. If a patient received both OAA and IO within 60 days of one another, then they were classified in the OAA/IO combination group; patients could not be assigned to more than one category. OAA = oral anticancer agent; OAA/IO = oral anticancer agent/immunotherapy combination therapy; IO = immunotherapy.
Figure 2.
Figure 2.
A) Mean Medicare payments by treatment type and diagnosis year in 2019 US dollars. B) Mean overall out-of-pocket responsibility by treatment type and diagnosis year in 2019 US dollars. OAA = oral anticancer agent; OAA/IO = oral anticancer agent/immunotherapy combination therapy; IO = immunotherapy, Tx = treatment.
Figure 3.
Figure 3.
A) Trends in monthly Medicare payments by cost category for patients who survived more than 12 months after metastatic renal cell carcinoma (mRCC) diagnosis. Costs are categorized into overall costs, treatment costs, inpatient costs (intensive care vs non–intensive care unit admission), and outpatient (emergency department, pharmacy, office visits, lab work, and other) costs. B) Trends in monthly Medicare payments by cost category for patients who lived less than 12 months after metastatic renal cell carcinoma (mRCC) diagnosis. Costs are categorized into overall costs, treatment costs, inpatient costs (intensive care vs non–intensive care unit admission), and outpatient (emergency department, pharmacy, office visits, lab work, and other) costs. USD = United States dollars; OAA = oral anticancer agent; OAA/IO = oral anticancer agent/immunotherapy combination therapy; IO = immunotherapy; Tx = treatment.
Figure 4.
Figure 4.
Trends in overall Medicare payments per patient over time by treatment category. We identified the earliest treatment a person received as OAA, IO, other, or none in the first year after diagnosis. If a patient received both OAA and IO within 60 days of one another, then they were classified in the OAA/IO combination group; patients could not be assigned to more than one category. OAA = oral anticancer agent; OAA/IO = oral anticancer agent/immunotherapy combination therapy; IO = immunotherapy.
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References

    1. Bahadoram S, Davoodi M, Hassanzadeh S, et al.Renal cell carcinoma: an overview of the epidemiology, diagnosis, and treatment. G Ital Nefrol. 2022;39(3). - PubMed
    1. Hudes G, Carducci M, Tomczak P, et al.; Global ARCC Trial. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356(22):2271-2281. - PubMed
    1. Motzer RJ, Hutson TE, Tomczak P, et al.Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115-124. - PubMed
    1. Escudier B, Eisen T, Stadler WM, et al.; TARGET Study Group. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356(2):125-134. - PubMed
    1. Choueiri TK, Hessel C, Halabi S, et al.Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk (Alliance A031203 CABOSUN randomised trial): progression-free survival by independent review and overall survival update. Eur J Cancer. 2018;94:115-125. - PMC - PubMed

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