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Cost trends of metastatic renal cell carcinoma therapy: the impact of oral anticancer agents and immunotherapy.
Forman, Rebecca; Long, Jessica B; Westvold, Sarah J; Agnish, Khushi; Mcmanus, Hannah D; Leapman, Michael S; Hurwitz, Michael E; Spees, Lisa P; Wheeler, Stephanie B; Gross, Cary P; Dinan, Michaela A.
Afiliación
  • Forman R; Section of Medical Oncology, Internal Medicine Department, Yale School of Medicine, New Haven, CT, USA.
  • Long JB; Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT, USA.
  • Westvold SJ; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
  • Agnish K; Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT, USA.
  • Mcmanus HD; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
  • Leapman MS; Yale School of Medicine, New Haven, CT, USA.
  • Hurwitz ME; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
  • Spees LP; Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT, USA.
  • Wheeler SB; Department of Urology, Yale School of Medicine, New Haven, CT, USA.
  • Gross CP; Section of Medical Oncology, Internal Medicine Department, Yale School of Medicine, New Haven, CT, USA.
  • Dinan MA; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
JNCI Cancer Spectr ; 8(5)2024 Sep 02.
Article en En | MEDLINE | ID: mdl-39133171
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Células Renales / Medicare / Gastos en Salud / Inmunoterapia / Neoplasias Renales / Antineoplásicos Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: JNCI Cancer Spectr Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
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XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Células Renales / Medicare / Gastos en Salud / Inmunoterapia / Neoplasias Renales / Antineoplásicos Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: JNCI Cancer Spectr Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido