Skip to main content
Log in

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

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Background

The economic burden of renal cell carcinoma (RCC) had been reported to be significant in a previous review published in 2011.

Objective

The objective of this study was to perform an updated review by synthesizing economic studies related to the treatment of RCC that have been published since the previous review.

Methods

We performed a literature search in PubMed, EMBASE, and the Cochrane Library, covering English-language studies published between June 2010 and August 2018. We categorized these articles by type of analyses [cost-effectiveness analysis (CEA), cost analysis, and cost of illness (COI)] and treatment setting (cancer status and treatment), discussed findings from these articles, and synthesized information from each article in summary tables.

Results

We identified 52 studies from 2317 abstracts/titles deemed relevant from the initial search, including 21 CEA, 23 cost analysis, and 8 COI studies. For localized RCC, costs were found to be positively associated with the aggressiveness of the local treatment. For metastatic RCC (mRCC), pazopanib was reported to be cost effective in the first-line setting. We also found that the economic burden of RCC has increased over time.

Conclusion

RCC continues to impose a substantial economic burden to the healthcare system. Despite the large number of treatment alternatives now available for advanced RCC, the cost effectiveness and budgetary impact of many new agents remain unknown and warrant greater attention in future research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. American Cancer Society. Cancer Facts & Figures 2018. Atlanta: American Cancer Society; 2018.

    Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.

    Article  Google Scholar 

  3. International Agency for Research on Cancer. Estimated number of incident cases, both sexes, kidney cancer, worldwide in 2012 [cited 17 Apr 2018]. https://gco.iarc.fr/today/online-analysis-table?mode=population&mode_population=continents&population=900&sex=0&cancer=21&type=0&statistic=0&prevalence=0&color_palette=default,%20accessed%202018%2F3%2F3.

  4. Barata PC, Rini BI. Treatment of renal cell carcinoma: current status and future directions. CA Cancer J Clin. 2017;67(6):507–24.

    Article  Google Scholar 

  5. Curti BD. Renal cell carcinoma. JAMA. 2004;292(1):97–100.

    Article  CAS  Google Scholar 

  6. National Comprehensive Cancer Network. NCCN Guidelines with NCCN Evidence Blocks: Clinical Practice Guidelines in Oncology: Kidney Cancer Version 4.2018. 2018. https://www.nccn.org/professionals/physician_gls/pdf/kidney_blocks.pdf. Accessed 1 May 2018.

  7. National Cancer Institute. Drugs Approved for Kidney (Renal Cell) Cancer. 2018. https://www.cancer.gov/about-cancer/treatment/drugs/kidney. Accessed 10 Apr 2018.

  8. Shih YC, Chien CR, Xu Y, Pan IW, Smith GL, Buchholz TA. Economic burden of renal cell carcinoma: Part I—an updated review. Pharmacoeconomics. 2011;29(4):315–29.

    PubMed  Google Scholar 

  9. Shih YC, Chien CR, Xu Y, Pan IW, Smith GL, Buchholz TA. Economic burden of renal cell carcinoma in the US: Part II—an updated analysis. Pharmacoeconomics. 2011;29(4):331–41.

    PubMed  Google Scholar 

  10. Health Information Research Unit. Search Filters for MEDLINE in Ovid Syntax and the PubMed translation. https://hiru.mcmaster.ca/hiru/hiru_hedges_medline_strategies.aspx. Accessed 1 Feb 2018.

  11. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. BMJ. 2013;346:f1049.

    Article  Google Scholar 

  12. Bureau of Labor Statistics. CPI Databases. https://www.bls.gov/cpi/data.htm. Accessed 10 Mar 2018.

  13. International Monetary Fund. World Economic Outlook Database. 2017. http://www.imf.org/external/pubs/ft/weo/2017/02/weodata/download.aspx. Accessed 30 Apr 2018.

  14. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

    Article  Google Scholar 

  15. Purmonen TT. Cost-effectiveness of sunitinib in metastatic renal cell carcinoma. Expert Rev Pharmacoecon Outcomes Res. 2011;11(4):383–93.

    Article  Google Scholar 

  16. Petrou P. A systematic review of economic evaluations of tyrosine kinase inhibitors of vascular endothelial growth factor receptors, mammalian target of rapamycin inhibitors and programmed death-1 inhibitors in metastatic renal cell cancer. Expert Rev Pharmacoecon Outcomes Res. 2018;18(3):255–65.

    Article  Google Scholar 

  17. Delea TE, Amdahl J, Diaz J, Nakhaipour HR, Hackshaw MD. Cost-effectiveness of pazopanib versus sunitinib for renal cancer in the United States. J Manag Care Spec Pharm. 2015;21(1):46–54 (a–b).

    PubMed  Google Scholar 

  18. Amdahl J, Diaz J, Park J, Nakhaipour HR, Delea TE. Cost-effectiveness of pazopanib compared with sunitinib in metastatic renal cell carcinoma in Canada. Curr Oncol. 2016;23(4):e340–54.

    Article  CAS  Google Scholar 

  19. Amdahl J, Diaz J, Sharma A, Park J, Chandiwana D, Delea TE. Cost-effectiveness of pazopanib versus sunitinib for metastatic renal cell carcinoma in the United Kingdom. PLoS One. 2017;12(6):e0175920.

    Article  Google Scholar 

  20. Capri S, Porta C, Delea TE. Cost-effectiveness of pazopanib versus sunitinib as first-line treatment for locally advanced or metastatic renal cell carcinoma from an italian national health service perspective. Clin Ther. 2017;39(3):pp. 567–80 e2.

    Article  Google Scholar 

  21. Motzer RJ, Hutson TE, Cella D, Reeves J, Hawkins R, Guo J, et al. Pazopanib versus sunitinib in metastatic renal-cell carcinoma. N Engl J Med. 2013;369(8):722–31.

    Article  CAS  Google Scholar 

  22. Calvo Aller E, Maroto P, Kreif N, Gonzalez Larriba JL, Lopez-Brea M, Castellano D, et al. Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain. Clin Transl Oncol. 2011;13(12):869–77.

    Article  CAS  Google Scholar 

  23. Benedict A, Figlin RA, Sandstrom P, Harmenberg U, Ullen A, Charbonneau C, et al. Economic evaluation of new targeted therapies for the first-line treatment of patients with metastatic renal cell carcinoma. BJU Int. 2011;108(5):665–72.

    PubMed  Google Scholar 

  24. Wu B, Dong B, Xu Y, Zhang Q, Shen J, Chen H, et al. Economic evaluation of first-line treatments for metastatic renal cell carcinoma: a cost-effectiveness analysis in a health resource-limited setting. PLoS One. 2012;7(3):e32530.

    Article  CAS  Google Scholar 

  25. Petrou PK, Talias MA. Cost-effectiveness of sorafenib compared to best supportive care in second line renal cell cancer from a payer perspective in Cyprus. Expert Rev Pharmacoecon Outcomes Res. 2014;14(1):131–8.

    Article  Google Scholar 

  26. Petrou P, Talias MA. A pilot study to assess feasibility of value based pricing in Cyprus through pharmacoeconomic modelling and assessment of its operational framework: sorafenib for second line renal cell cancer. Cost Eff Resour Alloc. 2014;12:12.

    Article  Google Scholar 

  27. Mihajlovic J, Pechlivanoglou P, Sabo A, Tomic Z, Postma MJ. Cost-effectiveness of everolimus for second-line treatment of metastatic renal cell carcinoma in Serbia. Clin Ther. 2013;35(12):1909–22.

    Article  Google Scholar 

  28. Paz-Ares L, del Muro JG, Grande E, Diaz S. A cost-effectiveness analysis of sunitinib in patients with metastatic renal cell carcinoma intolerant to or experiencing disease progression on immunotherapy: perspective of the Spanish National Health System. J Clin Pharm Ther. 2010;35(4):429–38.

    CAS  PubMed  Google Scholar 

  29. Giuliani J, Bonetti A. Nivolumab is a cost-effective second-line treatment for metastatic renal-cell carcinoma. Clin Genitourin Cancer. 2018;16(3):e557–62.

    Article  Google Scholar 

  30. Edwards SJ, Wakefield V, Cain P, Karner C, Kew K, Bacelar M, et al. Axitinib, cabozantinib, everolimus, nivolumab, sunitinib and best supportive care in previously treated renal cell carcinoma: a systematic review and economic evaluation. Health Technol Assess. 2018;22(6):1–278.

    Article  Google Scholar 

  31. Sarfaty M, Leshno M, Gordon N, Moore A, Neiman V, Rosenbaum E, et al. Cost effectiveness of nivolumab in advanced renal cell carcinoma. Eur Urol. 2018;73(4):628–34.

    Article  Google Scholar 

  32. Motzer RJ, Escudier B, Tomczak P, Hutson TE, Michaelson MD, Negrier S, et al. Axitinib versus sorafenib as second-line treatment for advanced renal cell carcinoma: overall survival analysis and updated results from a randomised phase 3 trial. Lancet Oncol. 2013;14(6):552–62.

    Article  CAS  Google Scholar 

  33. Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1803–13.

    Article  CAS  Google Scholar 

  34. Wan XM, Peng LB, Ma JA, Li YJ. Economic evaluation of nivolumab as a second-line treatment for advanced renal cell carcinoma from US and Chinese perspectives. Cancer. 2017;123(14):2634–41.

    Article  CAS  Google Scholar 

  35. McCrea C, Johal S, Yang S, Doan J. Cost-effectiveness of nivolumab in patients with advanced renal cell carcinoma treated in the United States. Exp Hematol Oncol. 2018;7:4.

    Article  Google Scholar 

  36. Raphael J, Sun Z, Bjarnason GA, Helou J, Sander B, Naimark DM. Nivolumab in the Treatment of metastatic renal cell carcinoma: a cost-utility analysis. Am J Clin Oncol. 2018;5:6–7. https://doi.org/10.1097/coc.0000000000000451 (Epub 4 May 2018).

    Article  Google Scholar 

  37. Meng J, Lister J, Vataire AL, Casciano R, Dinet J. Cost-effectiveness comparison of cabozantinib with everolimus, axitinib, and nivolumab in the treatment of advanced renal cell carcinoma following the failure of prior therapy in England. Clinicoecon Outcomes Res. 2018;10:243–50.

    Article  Google Scholar 

  38. Swallow E, Messali A, Ghate S, McDonald E, Duchesneau E, Perez JR. The additional costs per month of progression-free survival and overall survival: an economic model comparing everolimus with cabozantinib, nivolumab, and axitinib for second-line treatment of metastatic renal cell carcinoma. J Manag Care Spec Pharm. 2018;24(4):335–43.

    PubMed  Google Scholar 

  39. Casciano R, Chulikavit M, Di Lorenzo G, Liu Z, Baladi JF, Wang X, et al. Economic evaluation of everolimus versus sorafenib for the treatment of metastatic renal cell carcinoma after failure of first-line sunitinib. Value Health. 2011;14(6):846–51.

    Article  Google Scholar 

  40. Petrou P. Cost-effectiveness analysis of axitinib through a probabilistic decision model. Expert Opin Pharmacother. 2015;16(8):1233–43.

    Article  Google Scholar 

  41. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(8 Suppl):IV-3–-18.

    Google Scholar 

  42. Camp C, O’Hara J, Hughes D, Adshead J. Short-term outcomes and costs following partial nephrectomy in england: a population-based study. Eur Urol Focus. 2017. https://doi.org/10.1016/j.euf.2017.03.010.

    Article  PubMed  Google Scholar 

  43. Golombos DM, Chughtai B, Trinh QD, Mao J, Te A, O’Malley P, et al. Adoption of technology and its impact on nephrectomy outcomes, a U.S. population-based analysis (2008–2012). J Endourol. 2017;31(1):91–9.

    Article  Google Scholar 

  44. Golombos DM, Chughtai B, Trinh QD, Thomas D, Mao J, Te A, et al. Minimally invasive vs open nephrectomy in the modern era: does approach matter? World J Urol. 2017;35(10):1557–68.

    Article  Google Scholar 

  45. Kim SP, Leibovich BC, Shah ND, Weight CJ, Borah BJ, Han LC, et al. The relationship of postoperative complications with in-hospital outcomes and costs after renal surgery for kidney cancer. BJU Int. 2013;111(4):580–8.

    Article  Google Scholar 

  46. Kowalczyk KJ, Choueiri TK, Hevelone ND, Trinh QD, Lipsitz SR, Nguyen PL, et al. Comparative effectiveness, costs and trends in treatment of small renal masses from 2005 to 2007. BJU Int. 2013;112(4):E273–80.

    Article  Google Scholar 

  47. Larcher A, Sun M, Dell’Oglio P, Trudeau V, Boehm K, Schiffmann J, et al. Mortality, morbidity and healthcare expenditures after local tumour ablation or partial nephrectomy for T1A kidney cancer. Eur J Surg Oncol. 2017;43(4):815–22.

    Article  CAS  Google Scholar 

  48. Bahler CD, Monn MF, Flack CK, Gramm AR, Gardner TA, Sundaram CP. Assessing cost of robotic utilization in partial nephrectomy with increasing utilization. J Endourol. 2018;32(8):710–6.

    Article  Google Scholar 

  49. Chang YH, Chang SW, Liu CY, Lin PH, Yu KJ, Pang ST, et al. Demographic characteristics and complications of open and minimally invasive surgeries for renal cell carcinoma: a population-based case-control study in Taiwan. Ther Clin Risk Manag. 2018;14:1235–41.

    Article  Google Scholar 

  50. Takagi T, Sugihara T, Yasunaga H, Horiguchi H, Fushimi K, Kondo T, et al. Cytoreductive nephrectomy for metastatic renal cell carcinoma: a population-based analysis of perioperative outcomes according to clinical stage. Int J Urol. 2014;21(8):770–5.

    Article  Google Scholar 

  51. Villa G, Hernandez-Pastor LJ. Budget impact analysis of first-line treatment with pazopanib for advanced renal cell carcinoma in Spain. BMC Cancer. 2013;13:399.

    Article  Google Scholar 

  52. Hansen RN, Hackshaw MD, Nagar SP, Arondekar B, Deen KC, Sullivan SD, et al. Health care costs among renal cancer patients using pazopanib and sunitinib. J Manag Care Spec Pharm. 2015;21(1):pp. 37–44, a-d.

    Google Scholar 

  53. MacLean E, Mardekian J, Cisar LA, Hoang CJ, Harnett J. Real-world treatment patterns and costs for patients with renal cell carcinoma initiating treatment with sunitinib and pazopanib. J Manag Care Spec Pharm. 2016;22(8):979–90.

    PubMed  Google Scholar 

  54. Vogelzang NJ, Pal SK, Ghate SR, Swallow E, Li N, Peeples M, et al. Clinical and economic outcomes in elderly advanced renal cell carcinoma patients starting pazopanib or sunitinib treatment: a retrospective medicare claims analysis. Adv Ther. 2017;34(11):2452–65.

    Article  CAS  Google Scholar 

  55. Racsa PN, Whisman TR, Worley K. Comparing two tyrosine kinase inhibitors for treatment of advanced renal cell carcinoma in Medicare and commercially insured patients. Curr Med Res Opin. 2015;31(10):1933–40.

    Article  Google Scholar 

  56. Vogelzang NJ, Pal SK, Ghate SR, Li N, Swallow E, Peeples M, et al. Real-world economic outcomes during time on treatment among patients who initiated sunitinib or pazopanib as first targeted therapy for advanced renal cell carcinoma: a retrospective analysis of medicare claims data. J Manag Care Spec Pharm. 2018;24(6):525–33.

    PubMed  Google Scholar 

  57. Ravasio R, Ortega C, Sabbatini R, Porta C. Bevacizumab plus interferon-alpha versus sunitinib for first-line treatment of renal cell carcinoma in Italy: a cost-minimization analysis. Clin Drug Investig. 2011;31(7):507–17.

    Article  CAS  Google Scholar 

  58. Soerensen AV, Donskov F, Kjellberg J, Ibsen R, Hermann GG, Jensen NV, et al. Health economic changes as a result of implementation of targeted therapy for metastatic renal cell carcinoma: national results from DARENCA study 2. Eur Urol. 2015;68(3):516–22.

    Article  Google Scholar 

  59. Pal SK, Jonasch E, Signorovitch JE, Reichmann WM, Li N, Liu Z, et al. Real-world dosing and drug costs with everolimus or axitinib as second targeted therapies for advanced renal cell carcinoma: a retrospective chart review in the US. J Med Econ. 2016;19(5):462–8.

    Article  Google Scholar 

  60. Perrin A, Sherman S, Pal S, Chua A, Gorritz M, Liu Z, et al. Lifetime cost of everolimus vs axitinib in patients with advanced renal cell carcinoma who failed prior sunitinib therapy in the US. J Med Econ. 2015;18(3):200–9.

    Article  Google Scholar 

  61. Suo A, Iqbal U, Lim J, Lee C, Gesy K, Iqbal N, et al. Outcomes and drug costs of sunitinib regimens for metastatic renal cell carcinoma: a provincial population-based study. Clin Genitourin Cancer. 2017;15(3):e397–404.

    Article  Google Scholar 

  62. Geynisman DM, Hu JC, Liu L, Tina Shih YC. Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States. Clin Genitourin Cancer. 2015;13(2):e93–100.

    Article  Google Scholar 

  63. Shi G, Park SH, Ren H, Xue M, Lu X, Dong P, et al. Cost analysis for different sequential treatment regimens for metastatic renal cell carcinoma in China. J Med Econ. 2018. https://doi.org/10.1080/13696998.2018.1515769.

    Article  PubMed  Google Scholar 

  64. Maroun R, Mitrofan L, Benjamin L, Nachbaur G, Maunoury F, Le Jeunne P, et al. Real life patterns of care and progression free survival in metastatic renal cell carcinoma patients: retrospective analysis of cross-sectional data. BMC Cancer. 2018;18(1):214.

    Article  Google Scholar 

  65. Hollenbeak CS, Nikkel LE, Schaefer EW, Alemao E, Ghahramani N, Raman JD. Determinants of medicare all-cause costs among elderly patients with renal cell carcinoma. J Manag Care Pharm. 2011;17(8):610–20.

    PubMed  PubMed Central  Google Scholar 

  66. Lin DY. Linear regression analysis of censored medical costs. Biostatistics. 2000;1(1):35–47.

    Article  CAS  Google Scholar 

  67. Bang H, Tsiatis AA. Estimating medical costs with censored data. Biometrika. 2000;87(2):329–43.

    Article  Google Scholar 

  68. Brown ML, Riley GF, Schussler N, Etzioni R. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care. 2002;40(8 Suppl):IV-104–17.

    Google Scholar 

  69. Barlow WE. Overview of methods to estimate the medical costs of cancer. Med Care. 2009;47(7 Suppl 1):S33–6.

    Article  Google Scholar 

  70. Ballali S, Chiffi D, Trojniak MP, Gregori D. Agreement tE-VRP. Economic impact of sunitinib and sorafenib use in metastatic renal cell carcinoma treatment in Veneto region. Italy. Open Pharmacol J. 2013;7(Suppl 1):M2:2–8.

    Google Scholar 

  71. Maroun R, Fleury L, Nachbaur G, Maunoury F, Vanhille JL, Durand-Zaleski I. Real-world costs and outcomes in metastatic renal cell carcinoma patients treated with targeted therapies: a cohort study from the French health insurance database. Curr Med Res Opin. 2017;33(10):1755–62.

    Article  Google Scholar 

  72. Maroun R, Maunoury F, Benjamin L, Nachbaur G, Durand-Zaleski I. 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. PLoS One. 2016;11(9):e0162864.

    Article  Google Scholar 

  73. Purmonen T, Nuttunen P, Vuorinen R, Pyrhonen S, Kataja V, Kellokumpu-Lehtinen P. Current and predicted cost of metastatic renal cell carcinoma in Finland. Acta Oncol. 2010;49(6):837–43.

    Article  Google Scholar 

  74. Li P, Wong YN, Jahnke J, Pettit AR, Doshi JA. Association of high cost sharing and targeted therapy initiation among elderly Medicare patients with metastatic renal cell carcinoma. Cancer Med. 2018;7(1):75–86.

    Article  CAS  Google Scholar 

  75. Hagiwara M, Borker R, Oster G. Economic burden of adverse events in patients with metastatic renal cell carcinoma. Clin Ther. 2013;35(12):pp. 1955–63 e2.

    Article  Google Scholar 

  76. Hagiwara M, Hackshaw MD, Oster G. Economic burden of selected adverse events in patients aged ≥65 years with metastatic renal cell carcinoma. J Med Econ. 2013;16(11):1300–6.

    Article  Google Scholar 

  77. Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG. Cost-effectiveness in health and medicine. 2nd ed. New York: Oxford University Press; 2016.

    Book  Google Scholar 

  78. Ravaud A, Motzer RJ, Pandha HS, George DJ, Pantuck AJ, Patel A, et al. Adjuvant sunitinib in high-risk renal-cell carcinoma after nephrectomy. N Engl J Med. 2016;375(23):2246–54.

    Article  CAS  Google Scholar 

  79. Polascik TJ, Pound CR, Meng MV, Partin AW, Marshall FF. Partial nephrectomy: technique, complications and pathological findings. J Urol. 1995;154(4):1312–8.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Gary Deyter, technical writer from the Department of Health Services Research, The University of Texas MD Anderson Cancer Center, for his editorial contribution.

Data Availability Statement

The data (i.e. Excel file of all abstracts reviewed for this study) generated for the current study are available from the corresponding author upon reasonable request.

Author information

Authors and Affiliations

Authors

Contributions

Dr. Chien contributed to the study design; acquisition, analysis, and interpretation of the data; and drafting of the manuscript. Drs. Geynisman and Xu contributed to critical review of the manuscripts identified as a result of the search criteria, and commented on the interpretation of the study findings and critical revisions to the manuscript. Dr. Kim contributed to data analysis, information synthesis, and critical reviews/comments. Dr. Shih provided administrative support and senior supervision, and also contributed to the study design; acquisition, analysis, and interpretation of the data; and editing/revising each version of the draft manuscript. All authors approved the final version submitted for publication and agreed to be accountable for all aspects of the work. Dr. Shih acts as the overall guarantor.

Corresponding author

Correspondence to Ya-Chen Tina Shih.

Ethics declarations

Funding

We acknowledge funding from the China Medical University Hospital (Chien: CRS-106-040) and the National Cancer Institute (Shih: R01 CA207216 and CCSG P30 CA016672).

Conflicts of Interest

Drs. Chien, Geynisman, Xu, Kim, and Shih have no conflicts of interest (either financial or non-financial) to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chien, CR., Geynisman, D.M., Kim, B. et al. Economic Burden of Renal Cell Carcinoma—Part I: An Updated Review. PharmacoEconomics 37, 301–331 (2019). https://doi.org/10.1007/s40273-018-0746-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-018-0746-y

Navigation