Medicare patients with advanced renal cell carcinoma benefit from lower costs and hospital admissions if treated with pazopanib rather than sunitinib, according to research presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting (March 27-30, 2017).
Advanced renal cell carcinoma is commonly treated by first-line targeted therapies such as pazopanib and sunitinib. However, limited real-world data exists on the comparative economic benefits and hospital admissions associated with these targeted therapies.
Researchers from Novartis Pharmaceuticals and the University of Utah Huntsman Cancer Institute investigated the health care resource use and costs during time on targeted therapies among patients with advanced renal cell carcinoma. Patients who were ages 65 years or older with advanced disease and secondary neoplasm who initiated pazopanib (n = 526) or sunitinib (n = 1185) as first-line targeted therapy were identified from Medicare data from 2006 to 2014. Patient baseline characteristics were assessed 1 year prior to initial treatment and were routinely monitored until first treatment discontinuation, end of eligibility, end of data, or death, whichever occurred earliest.
Patients were stratified by first-line targeted therapy and matched 1:1 using propensity scores from baseline characteristics, comorbidities, health care resource use, and costs. Resulting outcomes were compared between the matched cohorts using generalized linear models.
After matching, all baseline characteristics, including median time of treatment duration (4.8 months for pazopanib cohort vs 4.1 months for sunitinib cohort, P = .169), were balanced (n = 522 for both cohorts). First-line targeted therapy with pazopanib was associated with significantly lower total health care costs ($8527 vs. $10,924, mean difference [MD]: $2397, P < .01), total pharmacy costs ($4536 vs. $5043, MD: $506, P < .01), total medical costs ($3991 vs. $5881, MD: $1890, P < .01), inpatient costs ($2040 vs. $3731, MD: $1692, P < .01), inpatient admissions (0.18 vs. 0.29, MD: 0.11, P < .01), 30 day inpatient readmissions (0.03 vs. 0.06, MD: 0.03, P < .05), and inpatient days (1.1 vs. 1.9, MD: 0.8, P < .01) while on treatment compared with first-line targeted therapy with sunitinib.
Researchers concluded that patients with advanced renal cell carcinoma use less health care resources, experience lower treatment costs, have lower inpatient admissions, and have a shorter length of stay if they are treated with pazopanib rather than sunitinib. Further research with a broader population base is needed to validate these conclusions. – Zachary Bessette
