Economic burden of adverse events in patients with metastatic renal cell carcinoma.

Abstract

BACKGROUND:

Although targeted therapies (ie, tyrosine kinase inhibitors and antiangiogenesis agents) are effective as first-line treatment of metastatic renal cell carcinoma (mRCC), moderate-to-severe adverse events have been reported in clinical trials of these agents. Information concerning the economic burden of these events is limited.

OBJECTIVE:

The purpose of this study was estimate the costs associated with adverse events in patients with mRCC receiving selected targeted agents indicated for first-line treatment of this disease.

METHODS:

Retrospective study based on health care claims data for patients with mRCC, aged ≥18 years, receiving first-line treatment with targeted therapies. Adverse events of interest included abdominal pain, back pain, diarrhea, dyspnea, extremity pain, fatigue and/or asthenia, hand-foot syndrome, hypertension, lymphopenia, nausea and/or vomiting, neutropenia, proteinuria, and thrombocytopenia. Patients receiving care for these events were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes on health care claims. Costs were examined during a 30-day period, beginning with date of first mention of each event; nonevented patients similarly were assigned a shadow index date. We estimated total costs during 30 days after the index date for patients with and without adverse events, excluding the costs of targeted therapy.

RESULTS:

Sixty-four percent of patients receiving targeted therapies for mRCC had health care encounters for ≥1 adverse events. Events that occurred with a frequency >20% included severe abdominal pain, back pain, fatigue and/or asthenia, and nausea and/or vomiting, respectively; 10% to 20% of patients had encounters for diarrhea, dyspnea, and extremity pain, respectively. Mean (SD) total costs of care during the 30-day, postevent period were substantially higher among patients with versus without adverse events-$12,177 ($19,621) versus $4070 ($8142). Adjusting for differences in baseline characteristics, the estimated cost difference was $11,373 (95% CI, $5286-$21,419).

CONCLUSIONS:

Costs of adverse events are substantial in patients receiving targeted therapies, specifically, sunitinib, sorafenib, or bevacizumab, for mRCC. Efforts to prevent and/or better manage these events may reduce health care costs.

• Authors: May Hagiwara, Rohit Borker, Gerry Oster
• Journal: Clinical therapeutics (Clin Ther) Vol. 35 Issue 12 Pg. 1955-1963.e2 (Dec 2013) ISSN: 1879-114X [Electronic] United States
• PMID: 24290735 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 Elsevier HS Journals, Inc. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• Antineoplastic Agents
• Protein Kinase Inhibitors

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (adverse effects, economics)
• Antineoplastic Agents (adverse effects, economics)
• Carcinoma, Renal Cell (drug therapy, economics, secondary)
• Cost of Illness
• Cost-Benefit Analysis (economics)
• Databases, Factual
• Health Care Costs
• Humans
• Insurance Claim Review
• Kidney Neoplasms (drug therapy, economics)
• Middle Aged
• Protein Kinase Inhibitors (adverse effects, economics)
• Retrospective Studies
• Severity of Illness Index
• Young Adult