Health Economic Changes as a Result of Implementation of Targeted Therapy for Metastatic Renal Cell Carcinoma: National Results from DARENCA Study 2

Soerensen, Anne Vest; Donskov, Frede; Kjellberg, Jakob; Ibsen, Rikke; Hermann, Gregers G.; Jensen, Niels Viggo; Fode, Kirsten; Geertsen, Poul F.

doi:10.1016/j.eururo.2014.12.017

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…In a Danish study, outpatient visits and inpatient hospitalisations were estimated to cost respectively 14,308€ and 11,899€ per patient per year. The Mean annual cost per patient for outpatient hospitalisations in our study was considerably lower than the estimated costs in the Danish study [ 8 ]. These differences might be explained by differences in health resource utilisation and related DRG tariffs between the two countries.…”

Section: Discussioncontrasting

confidence: 68%

“…Indeed, overall survival has improved from 13 months to 16 months with the use of targeted therapies as compared to the use of cytokine based treatments [ 6 ]. Most of these therapeutic innovations are orally administered, which modifies the management of mRCC [ 7 , 8 ]. A Danish study showed a shift in the costs of managing mRCC patients with a decrease of inpatient costs and an increase of outpatient costs [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Most of these therapeutic innovations are orally administered, which modifies the management of mRCC [ 7 , 8 ]. A Danish study showed a shift in the costs of managing mRCC patients with a decrease of inpatient costs and an increase of outpatient costs [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013

Maroun

Maunoury²,

Benjamin

et al. 2016

PLoS ONE

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Background & ObjectivesThe aim of this study was to assess the economic burden of hospitalisations for metastatic renal cell carcinoma (mRCC), to describe the patterns of prescribing expensive drugs and to explore the impact of geographic and socio-demographic factors on the use of these drugs.MethodsWe performed a retrospective analysis from the French national hospitals database. Hospital stays for mRCC between 2008 and 2013 were identified by combining the 10th revision of the International Classification of Diseases (ICD-10) codes for renal cell carcinoma (C64) and codes for metastases (C77 to C79). Incident cases were identified out of all hospital stays and followed till December 2013. Descriptive analyses were performed with a focus on hospital stays and patient characteristics. Costs were assessed from the perspective of the French National Health Insurance and were obtained from official diagnosis-related group tariffs for public and private hospitals.ResultsA total of 15,752 adult patients were hospitalised for mRCC, corresponding to 102,613 hospital stays. Of those patients, 68% were men and the median age at first hospitalisation was 69 years [Min-Max: 18–102]. Over the study period, the hospital mortality rate reached 37%. The annual cost of managing mRCC at hospital varied between 28M€ in 2008 and 42M€ in 2012 and was mainly driven by inpatient costs. The mean annual per capita cost of hospital management of mRCC varied across the study period from 8,993€ (SD: €8,906) in 2008 to 10,216€ (SD: €10,527) in 2012. Analysis of the determinants of prescribing expensive drugs at hospital did not show social or territorial differences in the use of these drugs.ConclusionThis study is the first to investigate the in-hospital economic burden of mRCC in France. Results showed that in-hospital costs of managing mRCC are mainly driven by expensive drugs and inpatient costs.

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

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In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013

Maroun

Maunoury²,

Benjamin

et al. 2016

PLoS ONE

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“…We have recently shown that implementation of targeted therapy did not lead to an increase in total health care costs per patient per treatment year compared with a pre-TKI era [ 25 ]. However, we have also previously shown that patients in IMDC poor prognostic group had limited OS benefit from treatment [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

A five-factor biomarker profile obtained week 4–12 of treatment for improved prognostication in metastatic renal cell carcinoma: Results from DARENCA study 2

et al. 2015

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Background: Several biomarkers of treatment efficacy have been associated with a better prognosis in patients with metastatic renal cell carcinoma (mRCC). The prognostic significance of biomarkers in the early treatment phase is unclear. Material and methods: In a complete national cohort of mRCC patients receiving first-line tyrosine kinase inhibitors (TKI) or interleukin-2 based immunotherapy (IT) from 2006 to 2010, overall survival (OS) was analysed for baseline International mRCC Database Consortium (IMDC) classification factors and on-treatment time-dependent biomarkers obtained day 1 each cycle week 4–12 after treatment initiation with multivariate analysis and bootstrap validation. Results: A total of 735 patients received first-line TKI (59%) or IT (41%). Median OS was overall 14.0 months and 33.4, 18.5, and 5.8 months for baseline IMDC favourable, intermediate, and poor risk groups, respectively (p < 0.0001). Systolic blood pressure ≥140 mmHg, neutrophils < lower level of normal (LLN), platelets < LLN, sodium ≥ LLN, and LDH ≤1.5 times upper level of normal after treatment initiation were significantly associated with favourable OS independent of baseline IMDC risk group in multivariate analyses stratified for TKI and IT (p ≤ 0.04). Concordance (C)-index for IMDC classification alone was 0.625 (95% CI 0.59–0.66) and combined with the five-factor biomarker profile 0.683 (95% CI 0.64–0.72). For patients with good (3–5 factors) and poor (0–2 factors) biomarker profile median OS were 23.5 and 9.6 months, respectively (p < 0.0001). Adding the five-factor biomarker profile significantly improved prognostication in IMDC intermediate (25.7 vs. 12.0 months, p < 0.0001) and poor (12.8 vs. 6.4 months, p < 0.0001) risk groups. A trend was seen in IMDC favourable risk group (38.9 vs. 28.7 months, p = 0.112). Conclusion: On-treatment hypertension, neutropenia, thrombocytopenia, LDH below 1.5 times upper level of normal, and normal sodium, obtained week 4–12 of treatment, are independent biomarkers of favourable outcome in mRCC, independent of treatment type.

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“…The cost-effectiveness of TTs in the mRCC setting has been evaluated using clinical trial data 13,14. A number of studies have confirmed the survival benefits of TTs in patients with mRCC in clinical practice15–23 and one study estimated the cost impact of TTs in a national cohort of patients with mRCC;11 however, to the best of our knowledge, no studies have estimated the cost-effectiveness of TTs using real-world data. Given the limited trial data evidence of overall survival gains and uncertain external validity of randomized clinical trials, real-world cost-effectiveness analyses may provide important information for clinicians and payers on the value of TTs in the treatment of patients with mRCC and, in turn, facilitate improved decision-making and resource allocation.…”

Section: Introductionmentioning

confidence: 99%

<p>Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden: a population-based retrospective analysis</p>

Redig¹,

Dalén²,

Harmenberg³

et al. 2019

CMAR

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ObjectiveTo explore cost-effectiveness of targeted therapies (TTs) in the treatment of metastatic renal cell carcinoma (mRCC) in a real-world context using a nationwide population-based approach.MethodsData on patients diagnosed with mRCC between 2002 and 2012 were extracted from Swedish national health data registers. To facilitate comparisons of patients diagnosed before and after TT introduction to the market, three cohorts were derived: pre-TT introduction (preTT), patients diagnosed 2002–2005; early TT introduction (TTi), patients diagnosed 2006–2008; and late TT introduction (TTii), which was limited to patients diagnosed 2009–2010 to ensure availability of total health care resource utilization (HCRU) data. Patients were followed until end of 2012. The value of TTs across cohorts was estimated using mean HCRU costs per life-year (LY) gained. Data on HCRU were obtained through national health registers for dispensed medication and inpatient and outpatient care, and the associated costs were estimated using the Lin method to account for censoring. LYs gained were defined as the difference in mean survival over the study period.ResultsThe preTT, TTi, and TTii cohorts consisted of 1,366, 1,158, and 806 patients, respectively. Mean survival in years from mRCC diagnosis was 1.45 in the preTT cohort, 1.62 in the TTi cohort, and 1.83 in the TTii cohort. The respective mean total HCRU cost per patient over the study period was US$16,894, US$29,922, and US$30,037. The cost per LY gained per cohort was US$78,656 for TTi vs preTT, US$34,132 for TTii vs preTT, and US$523 for TTii vs TTi.ConclusionGiven common willingness-to-pay per LY gained thresholds, this study in a real-world population suggests the use of TTs in the Swedish mRCC population is increasingly cost-effective over time.

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Health Economic Changes as a Result of Implementation of Targeted Therapy for Metastatic Renal Cell Carcinoma: National Results from DARENCA Study 2

Cited by 12 publications

References 21 publications

In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013

In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013

A five-factor biomarker profile obtained week 4–12 of treatment for improved prognostication in metastatic renal cell carcinoma: Results from DARENCA study 2

<p>Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden: a population-based retrospective analysis</p>

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