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Higher Health Care Resource Utilization, Rates of Mortality and Economic Burdens in Recurrence of Renal Cell Carcinoma
Renal cell carcinoma (RCC) recurrence is correlated with a significant increase in mortality, health care resource utilization (HRU), and health care costs, emphasizing the substantial unmet need in patients with intermediate high-risk and high-risk RCC post-nephrectomy when adjuvant therapies are not extensively available (J Manag Care Spec Pharm. 2022;28(10):1149-1160. doi:10.18553/jmcp.2022.22133).
Dr Murali Sundaram, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co, Inc, Rahway, NJ and colleagues sought to quantify the incremental clinical and economic burden correlated with disease recurrence among patients with intermediate high-risk and high-risk RCC post-nephrectomy.
The authors noted that to the best of their knowledge, this study was the first to evaluate HRU and health care costs linked with recurrence and to compare overall survival (OS) between patients with versus without recurrence among patients with intermediate high-risk and high-risk RCC post-nephrectomy using real-world data.
This retrospective observational study was conducted utilizing data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2007-2016) to identify patients with newly diagnosed, intermediate high-risk or high-risk RCC following nephrectomy.
Patients with a diagnosis of metastatic disease or repeat nephrectomy or initiating a systemic treatment for advanced RCC were categorized as the recurrence cohort; patients without evidence of recurrence were grouped as the cohort without recurrence. HRU, health care costs (2019 US dollars), and overall survival (OS) were compared between cohorts with and without recurrence, adjusting for demographic and clinical characteristics.
A total of 269 patients with recurrence and 374 patients without recurrence were evaluated with average age being 75.2 and 75.7 years (P = 0.383), respectively, and 64.7% and 57.8% (P = 0.076) of patients were male, respectively. Average follow-up duration was 17 and 28 months, respectively. Patients with recurrence had a considerably shorter OS relative to patients without recurrence (adjusted hazard ratio = 6.00; 95% CI = 4.24-8.48; P < 0.001).
Furthermore, compared with patients without recurrence, patients with recurrence had considerably more inpatient admissions (0.16 vs 0.04 admissions per person-month [PM]; adjusted incidence rate ratio [aIRR] = 3.88; 95% CI = 3.12-4.81), outpatient visits (3.06 vs 1.77 visits per PM; aIRR = 1.68; 95% CI = 1.56-1.81), emergency department visits (0.10 vs 0.05 visits per PM; aIRR = 2.11; 95% CI = 1.66-2.68), and days hospitalized (1.40 vs 0.35 days per PM; aIRR = 6.73; 95% CI = 4.95-9.15) per patient per month (all P < 0.001).
Adjusted average monthly health care costs per patient were considerably greater among patients with recurrence vs patients without recurrence (differences of all-cause total costs, total medical costs, and pharmacy cost per month: $6,320, $4,924, and $1,387; all P < 0.001).
The authors noted that in general, results from this evaluation demonstrated that patients with RCC recurrence had a substantially shorter OS compared with patients without evidence of recurrence. Furthermore, after adjusting for baseline characteristics, patients with RCC recurrence acquired considerably greater all-cause and RCC-related HRU and health care costs during the study period.
The authors concluded, “Taken together, these findings describe the unmet needs in the real world associated with preventing or delaying recurrence in patients with RCC post-nephrectomy and can provide context to future analyses evaluating the costs of effective adjuvant therapies.”
