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Economic Burden of Renal Cell Carcinoma in the US

Part II–An Updated Analysis

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Abstract

Introduction: The economic burden of renal cell carcinoma (RCC) came into sharp focus when the UK’s National Institute for Health and Clinical Excellence denied coverage (later reversed) of sunitinib for metastatic RCC. Following an updated review of RCC-related economic studies, we supplemented the costs of RCC reported in the literature with estimates from the latest US databases that capture the utilization of several newly approved targeted agents.

Method: We conducted analyses using the 1991–2007 SEER (Surveillance, Epidemiology and End Results)-Medicare and 1996–2007 MarketScan Commercial Claims and Encounter (CCAE) and Medicare Supplemental databases, and based our estimates on a prevalent cohort of patients with RCC or kidney cancer constructed from each database. All cost estimates were normalized to $US, year 2009 values. The incremental costing approach was applied to estimate the annual cost of RCC by treatment phases using a prevalent cohort of patients with RCC identified from the 2005 SEERMedicare database. We used the method of extended estimation equations to estimate the impact of patients’ use of targeted therapies on the annual costs of RCC, while controlling for confounding factors such as patients’ age, sex, tumour characteristics, co-morbidity and geographic regions. The method was applied to two elderly cohorts of RCC patients identified from the SEER-Medicare and the MarketScan Medicare Supplemental databases and a non-elderly cohort of patients with RCC identified from the Market Scan CCAE database.

Results: Compared with the cost of treating an elderly, non-cancer patient in the matched sample, the average cost of treating an elderly patient with RCC was $US11 169 (95% CI 10683, 11655) more per year, based on our analyses of the latest SEER-Medicare data. The annual cost to treat patients with RCC who received targeted therapies was 3- to 4-fold greater than the cost to treat patients with RCC who received other therapies. Results from the multivariate analysis showed that, after controlling for potential confounders, the annual medical cost was $US31000–65000 higher for RCC patients treated with targeted therapies, with the largest increase observed among the nonelderly patients.

Conclusion: The economic burden of RCC is likely to grow with an increasing use of targeted therapies. Future research is needed to understand the impact of various forces on the economic burden of RCC, such as increased disease incidence, use of minimally invasive surgical techniques and more prevalent adoption of emerging targeted therapies.

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Notes

  1. Although oral prescription drugs are covered under Medicare Part D, the latest release of SEER-Medicare data has not yet added Part D claims to the data.

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Acknowledgements

This research was partially funded by a grant from the Agency for Healthcare Research and Quality (AHRQ, R01 HS018535) to Ya-Chen Tina Shih, and a grant from the China Medical University Hospital, Taiwan (DMR-98-132) and a grant from the Department of Health, Taiwan (DOH99-TD-C-111005) to Chun-Ru Chien. The authors thank Ms LeeAnn Chastain for her editorial contributions. The interpretation and reporting of these data are the responsibilities of the authors and should in no way be viewed as an official policy or interpretation of the AHRQ. 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 (NCI); the Office of Research, Development and Information, Centers for Medicare & Medicaid Services (CMS); Information Management Services (IMS), Inc; and the SEER Program tumour registries in the creation of the SEER-Medicare database.

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Authors and Affiliations

  1. Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Ya-Chen T. Shih (Associate Professor), Ying Xu & I-Wen Pan

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

    Chun-Ru Chien

  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Grace L. Smith & Thomas A. Buchholz

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  1. Ya-Chen T. Shih
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  2. Chun-Ru Chien
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  3. Ying Xu
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  6. Thomas A. Buchholz
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Correspondence to Ya-Chen T. Shih.

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Shih, YC.T., Chien, CR., Xu, Y. et al. Economic Burden of Renal Cell Carcinoma in the US. Pharmacoeconomics 29, 331–341 (2011). https://doi.org/10.2165/11586110-000000000-00000

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