816P - First-line targeted agents and cost of care for patients with metastatic renal cell cancer (mRCC)

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Renal Cell Cancer
Bioethics, Legal, and Economic Issues
Presenter Yun Su
Authors Y. Su1, N. Shi2, P. Landsman-Blumberg3, C. Poehlein4, I. Waxman5
  • 1Global Health Economics & Outcomes Research, Bristol-Myers Squibb, Princeton/US
  • 2Pharma/biotech, Thomson Reuters Healthcare, Cambridge/US
  • 3Outcomes Research, Thomson Reuters, Washington DC/US
  • 4Hq Global Medical Affairs, Immuno-oncology, Bristol-Myers Squibb, Princeton/US
  • 5Oncology, Bristol-Myers Squibb, Princeton/US

Abstract

Objectives

Between 2005 and 2009, six targeted agents were approved for the treatment of mRCC in the US. Selection of agents for first and subsequent lines of therapy is important in optimizing outcomes. We aim to determine the impact of first-line agents on total costs of care in mRCC patients.

Methods

Adult patients with mRCC diagnosed from Jan 1, 2006 to Dec 31, 2010 were identified from a large commercial insurance claims and Medicare supplemental database in the US. Follow-up ≥3 months and ≥1 pharmacy or medical claims on or after metastasis diagnosis date were required for one of the targeted agents: sunitinib (SUN), sorafenib (SOR), pazopanib (PAZ), everolimus (EVE), temsirolimus (TEM), or bevacizumab (BEV) ± interferon α. Costs were measured in 2010 US dollars per patient per month (PPPM) over the entire follow-up period, and included patient out-of-pocket (OOP) costs, insurance-paid costs for mRCC drugs, other outpatient prescriptions (Rx), inpatient services, emergency room visits (ER), office visits, and other outpatient services including lab, radiology, outpatient surgery, and office-administered medications.

Results

1,622 patients were identified. 1,079 received first-line SUN, 284 SOR, 168 TEM, 40 PAZ, 26 EVE, and 25 BEV. With a median follow-up of 13 months, the mean healthcare cost PPPM was:

1st-line Agent Cost PPPM
Total Inpatient Other outpatient mRCC drugs
TEM $15,900 $6,480 $4,959 $3,532
BEV $15,429 $6,529 $3,795 $4,021
EVE $14,519 $3,585 $6,007 $4,063
SUN $14,084 $6,208 $3,834 $2,965
PAZ $12,461 $5,049 $3,895 $2,766
SOR $12,266 $4,759 $3,662 $3,938

Inpatient costs accounted for the largest share of total cost. Other outpatient services and mRCC drug costs were the next largest cost drivers. ER and office visits and other Rx each averaged less than $500 PPPM. OOP cost averaged $453 PPPM, but ranged from $380 for EVE to $2,045 for BEV.

Conclusions

Different first-line targeted agents appear to be associated with different total costs of care in mRCC. Patient characteristics, incidence and severity of adverse events, rates and duration of response, and choice of subsequent therapies may all play a role. Further characterization of such underlying factors may help optimize patient care and reduce cost.

Disclosure

Y. Su: Employment or Leadership Role: Bristol-Myers Squibb (employment, myself, compensated). Stock Ownership: Bristol-Myers Squibb (myself).

P. Landsman-Blumberg: Stock Ownership: Merck & Co., Inc. (myself).

C. Poehlein: Employment or Leadership Role: Bristol-Myers Squibb (employment, myself, compensated). Stock Ownership: Bristol-Myers Squibb (myself).

I. Waxman: Employment or Leadership Role: Bristol-Myers Squibb (employment, myself, compensated). Stock Ownership: Bristol-Myers Squibb (myself).

All other authors have declared no conflicts of interest.