Therapy targeting the vascular endothelial growth factor and mammalian target of rapamycin pathways are now the standard of care for patients (pts) with mRCC. However few studies have examined real-world treatment patterns and the impact on HRU and costs associated with these novel agents.
A retrospective study using a large, national US claims database from 7/2009-6/2015 was conducted. Commercially insured (COM) and Medicare Advantage (MA) newly diagnosed adult RCC pts (≥2 claims with ICD-9 189.0x) with ≥2 claims for metastases (mets) were identified; the first met claim date was the index date. Pts were required to be continuously enrolled (CE) in the health plan for 6m pre- and ≥1m post-index date and initiate systemic cancer therapy. Pts with other cancers or systemic cancer therapy in the baseline were excluded. Treatment patterns by line of therapy (LOT) were examined. A LOT started at the first date of cancer therapy and the regimen included all drugs received within 30 days. LOTs ended at the earliest of, start of a new drug, ≥60-day gap in initial regimen, death or CE end. All-cause per patient per month (PPPM) HRU and costs (in US$) during LOT1, LOT2 and LOT3 by regimen were examined.
There were 929 mRCC pts identified; 67% of pts were male, 47% were ≥65 yrs (mean age 63) and 37% were MA pts vs. 63% COM. Among all pts, 44% (n = 409) and 20% (n = 187) had a LOT2 and LOT3 during the study period. Mean total follow-up time was 17m, and mean duration of LOT1, LOT2 and LOT3 was 4.9m, 4.6m and 4.2 m respectively. The most common regimens were sunitinib (42%), pazopanib (22%) and temsirolimus (16%) for LOT1, everolimus (24%), pazopanib (20%) and sunitinib (17%) for LOT2, and axitinib (24%), pazopanib (21%) and everolimus (17%) for LOT3. HRU, including inpatient stays (0.29, 0.24 and 0.26 PPPM for LOT1, LOT2 and LOT3), varied by regimen. Total PPPM costs were US$21,884, US$20,116 and US$21,173 for LOT1, LOT2 and LOT3 respectively but varied by regimen.
With the emergence of new therapy options for mRCC, there is heterogeneity in treatment patterns with high associated HRU and costs. Future studies should examine optimal treatment sequencing.
Clinical trial identification
Legal entity responsible for the study
Eisai, Inc and Optum
R. Copher: Employment at Eisai, Inc Stock ownership (Eisai). S. Dacosta Byfield, P. Buzinec: Employment with Optum. Optum received payment from Eisai, Inc to conduct the study being presented but employment is not dependent on Optum's study with Eisai. Stock ownership (Optum/UnitedHealth). S. Korrer: Employment with Optum. Optum received payment from Eisai, Inc to conduct the study being presented but employment is not dependent on Optum's study with Eisai. Stock ownership (Optum/UnitedHealth). M. Baig: Employment with Eisai, Inc.