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Rising Economic Burden of Renal Cell Carcinoma among Elderly Patients in the USA: Part II—An Updated Analysis of SEER-Medicare Data

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Abstract

Background

The influx of new oncologic technologies has changed the treatment landscape of renal cell carcincoma (RCC) in the last decade. This study updated a previously published paper on the economic burden of RCC in the USA by using more recent data to examine the impact of various forms of new oncologic technologies on the economic burden of RCC.

Methods

Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we employed prevalence and incidence costing approaches to estimate RCC costs from the payer’s perspective. We conducted a longitudinal analysis of cost data per patient per month for a prevalence cohort of patients with RCC to determine which category of new technology (surgery, radiation, or cancer drugs) was the major cost driver for RCC. We then applied the incidence costing approach to estimate costs related to RCC by care phase (initial, continuing, and terminal) and compared costs between two incidence cohorts to examine how new technology affected the economic burden of RCC over time.

Results

After controlling for demographic factors, clinical characteristics, neighborhood socioeconomic status, and time trend, we found that rising per patient per month costs were driven by new technologies in cancer drugs. Incidence-based analysis showed the annual net cost (2018 US$) for patients with distant-stage RCC diagnosed between 2002 and 2006 was $51,639, $19,025, $76,603, and $29,045 for the initial, continuing (year 1), terminal (died from RCC), and terminal (died from other causes) care phases, respectively. Costs increased to $70,703, $34,716, $107,989, and $47,538, respectively, for the incidence cohort diagnosed between 2007 and 2011.

Conclusion

The rising economic burden of RCC was most pronounced among patients with distant-stage RCC, and driven primarily by new cancer drugs.

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Data Availability

Access to the data used in the current study (i.e., SEER-Medicare) is strictly limited to members of the research team who signed the Data Use Agreement at the corresponding author’s institution. As per the Data Use Agreement, authors of this study have no authority to grant data access to SEER-Medicare data nor distribute any subset of the data to individuals outside the research team.

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Acknowledgements

The authors thank Dr. Gary Deyter, technical writer from the Department of Health Services Research at The University of Texas MD Anderson Cancer Center for his editorial contribution. The interpretation and reporting of these data are the responsibilities of the authors and should not be viewed as an official policy or interpretation of the National Cancer Institute. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute, the Office of Research, Development and Information, Centers for Medicare & Medicaid Services, Information Management Services, Inc., and the SEER Program tumor registries in the creation of the SEER-Medicare database.

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Author notes

  1. Ya-Chen Tina Shih and Ying Xu are Joint first authors.

Authors and Affiliations

  1. Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Univ 1444, Houston, TX, 77030, USA

    Ya-Chen Tina Shih, Ying Xu & Bumyang Kim

  2. Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan

    Chun-Ru Chien

  3. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Chun-Ru Chien

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Yu Shen & Liang Li

  5. Department of Hematology/Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA

    Daniel M. Geynisman

Authors
  1. Ya-Chen Tina Shih
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Contributions

Y-CTS contributed to the study design, data acquisition, analysis and interpretation, and drafting of the manuscript. She also provided administrative support and acted as the overall guarantor. YX contributed to the study design and data analysis, and reviewed the manuscript for its scientific content and to ensure the accuracy of the data generation process. C-RC and DMG provided clinical insights and conducted critical reviews and revisions of the manuscript. BK assisted YX in compiling the list of anticancer medications and contributed to critical reviews/comments. YS and LL provided statistical expertise and conducted critical reviews and revisions with a special focus on the accuracy of the statistical analysis and interpretation. All authors approved the final version that was submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ya-Chen Tina Shih.

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Funding

We acknowledge funding from the China Medical University Hospital (Chien, CRS-108-054) and the National Cancer Institute (Shih, R01 CA207216, R01 CA225646, R01 CA225647 and CCSG P30 CA016672; Li R01 CA225646; Shen Cancer Center Biostatistics Shared Resource CA016672).

Conflict of interest

Ying Xu, Bumyang Kim, Yu Shen, and Liang Li have no conflicts of interest (either financial or non-financial) that are directly relevant to the content of this article. Ya-Chen Tina Shih received consulting fees for serving on a review panel for Pfizer Inc; the consulting activity was not related to this study. Chun-Ru Chien received consulting fees and travel support from AstraZeneca; the consulting activities were not related to this study. Daniel M. Geynisman received consulting fees from Genentech and AstraZeneca; none of the consulting activities were related to this study.

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Shih, YC.T., Xu, Y., Chien, CR. et al. Rising Economic Burden of Renal Cell Carcinoma among Elderly Patients in the USA: Part II—An Updated Analysis of SEER-Medicare Data. PharmacoEconomics 37, 1495–1507 (2019). https://doi.org/10.1007/s40273-019-00824-2

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  • DOI: https://doi.org/10.1007/s40273-019-00824-2

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