Economic Burden of Renal Cell Carcinoma—Part I: An Updated Review

Chien, Chun Ru; Geynisman, Daniel M.; Kim, Bumyang; Xu, Ying

doi:10.1007/s40273-018-0746-y

Cited by 30 publications

(19 citation statements)

References 73 publications

(84 reference statements)

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“…More recent economic analyses have been marked by broad heterogeneity in cost definitions, populations, interventions, and parameters. Nonetheless, the present study results do generally align with a 2019 systematic literature review of the US economic burden of RCC, which observed rising costs overall and total 1L annual costs of TKI monotherapies (in 2006-2014 datasets) ranging from approximately $73,000 to $149,000 (adjusted to 2018 US dollars), with a top range slightly lower than TKI results in the present study (approximately $163,000 yearly) [36]. Some of this discrepancy could be due to variation in population and study design, but the present results warrant more sensitive investigation of whether the costs of treating the disease are continuing to increase, and if so, why.…”

Section: Discussionsupporting

confidence: 88%

Real-World Outcomes Among US Veterans Health Administration Patients Newly Diagnosed with Metastatic Renal Cell Carcinoma and Treated with First-Line Monotherapy

et al. 2021

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Introduction Substantial unmet needs exist among patients with metastatic renal cell carcinoma (mRCC). This retrospective study evaluated treatment patterns as well as clinical and economic outcomes associated with first-line monotherapy among patients with mRCC in the USA. Methods Newly diagnosed patients with mRCC initiating at least one first-line therapy (1L) from 1 October 2013 to 31 March 2018 (index date = 1L start date) were identified from the US Veterans Health Administration database. Treatment patterns, clinical outcomes (time to next treatment [TNT] defined by earliest of switch to non-index therapy or re-initiation of index therapy after a more than 90-day gap, time to treatment discontinuation [TTD], overall survival [OS]), and costs were evaluated among patients treated with tyrosine kinase inhibitors (TKI), mammalian target of rapamycin inhibitors (mTOR), immune checkpoint inhibitors (ICI), and other monotherapies. Standard descriptive statistics were presented. The Kaplan–Meier method was used to evaluate clinical outcomes. Results Of 759 patients (median age 68.0 years), 85.0%, 8.0%, 4.3%, and 2.6% were treated with TKI, mTOR, ICI, or other therapy in 1L, respectively. Advancement rates (to second-line [2L] therapy) ranged from 10.0 (ICI) to 45.1 per 100 person years (TKI). The 12-month OS rates ranged from 47.4% (TKI) to 67.7% (mTOR). The median TNT ranged from 3.8 (mTOR) to 9.6 months (ICI), and median TTD ranged from 2.3 (mTOR) to 4.7 months (TKI). Total all-cause mean costs per patient per month ranged from $12,466 (mTOR) to $19,812 (ICI). Conclusion These results indicate high unmet medical needs among patients with mRCC treated with 1L monotherapies. Novel combination therapies (e.g., ICI + ICI, ICI + TKI) may improve front-line outcomes for patients with poor prognoses.

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Section: Discussionsupporting

confidence: 88%

Real-World Outcomes Among US Veterans Health Administration Patients Newly Diagnosed with Metastatic Renal Cell Carcinoma and Treated with First-Line Monotherapy

et al. 2021

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“…The studies identified looked at the US health care system, where disparities in costs of different treatments have been suggested to affect treatment decision-making. Chun-Ru Chien et al indicated that costs appeared to rise with aggressiveness of the local treatment in the US 72 . Nevertheless, there is significant inequality in access to healthcare and insurance in the US 73 , which introduces an additional systemic factor that may affect treatment decision-making, which may not apply to other countries.…”

Section: Economic Variablesmentioning

confidence: 99%

The Current Evidence for Factors that Influence Treatment Decision Making in Localized Kidney Cancer: A Mixed Methods Systematic Review

et al. 2021

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Introduction: With a growing number of treatment options for localised kidney cancer, patients and health care professionals have both the opportunity and the burden of selecting the most suitable management option. This mixed method systematic review aims to understand the barriers and facilitators of the treatment decision-making process in localised kidney cancer. Methods: We searched PubMed, Embase, and Cochrane Central databases between 1st of January 2004 and 23rd of April 2020 using the JBI Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We identified 553 unique citations, of these 511 were excluded resulting in 42 articles included for synthesis. The Purpose, Respondents, Explanation, Findings and Significance and the Strengthening the Reporting of Observational Studies in Epidemiology checklist were applied. Results: The key themes describing barriers and facilitators to treatment decisionmaking were identified and categorised into three domains: (1) kidney cancer specific characteristics; (2) decision-maker related criteria; and (3) contextual factors.The main facilitators identified within these domains were: size at diagnosis, age, comorbidities, BMI, gender, nephrometry scoring systems, biopsy, socio-economic status, family history of cancer, year of diagnosis, geographic region and practice pattern. The key barriers were race, gender, patient anxiety, low confidence in diagnostic and treatment options, cost of procedure and practice patterns.

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“…Despite previous comparative publications available to treat mRCC, simpler and more practical pharmacoeconomic analyzes for health decision-making process in Brazil are needed. Even after improvement on mRCC management, high costs are still imposed to healthcare system, patients and the whole society 41 . Some novel tools to optimize the cost/ effectiveness of immunotherapy in RCC have been proposed, such as fixed dose assessment, determination of biomarkers to promote early treatment cessation and the improvement of treatment length.…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab plus axitinib and nivolumab plus ipilimumab as first-line treatments of advanced intermediate- or poor-risk renal-cell carcinoma: a number needed to treat analysis from the Brazilian private perspective

Engel

Abadi

Haas

et al. 2021

Journal of Medical Economics

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Background: Considering clinical benefits of new combination therapies for metastatic renal-cell carcinoma (mRCC), this study aims to calculate the number needed to treat (NTT) and the cost of preventing an event (COPE) for pembrolizumab plus axitinib (P þ A), and nivolumab plus ipilimumab (N þ I) as first-line treatments, from the Brazilian private perspective. Methods: Overall survival (OS) and progression-free survival (PFS) data for intermediate-and poor-risk groups were obtained from KEYNOTE-426 and CHECKMATE-214 trials for P þ A and N þ I, respectively, versus sunitinib as mRCC first-line treatment. Results: Considering a 12-month time horizon, 6 patients should be treated with P þ A to prevent one death with sunitinib use, resulting in a COPE of 3,773,865 BRL. Using N þ I, NNT for 12-month OS rate was 13 compared to sunitinib, with a COPE of 6,357,965 BRL. Regarding PFS data, NNT was also 6 when comparing P þ A versus sunitinib, with an estimated COPE of 3,773,865 BRL. Estimated NNT was 20 comparing N þ I and sunitinib, resulting in a COPE of 10,172,744 BRL. Cost differences between two treatment options, reached more than 6 million BRL for PFS, and 2 million BRL for OS. Conclusion: At the 12-month landmark, P þ A suggests better economic scenario versus N þ I as firstline mRCC treatment option for intermediate-and poor-risk groups, through an indirect comparison using sunitinib as a common comparator.

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Economic Burden of Renal Cell Carcinoma—Part I: An Updated Review

Cited by 30 publications

References 73 publications

Real-World Outcomes Among US Veterans Health Administration Patients Newly Diagnosed with Metastatic Renal Cell Carcinoma and Treated with First-Line Monotherapy

Real-World Outcomes Among US Veterans Health Administration Patients Newly Diagnosed with Metastatic Renal Cell Carcinoma and Treated with First-Line Monotherapy

The Current Evidence for Factors that Influence Treatment Decision Making in Localized Kidney Cancer: A Mixed Methods Systematic Review

Pembrolizumab plus axitinib and nivolumab plus ipilimumab as first-line treatments of advanced intermediate- or poor-risk renal-cell carcinoma: a number needed to treat analysis from the Brazilian private perspective

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