Duh Mei Sheng, Dial Ellison, Choueiri Toni K, Fournier Andree-Anne, Antras Lucia, Rodermund Douglas, Neary Maureen P, Oh William K
Analysis Group, Inc., Boston, MA 02199, USA.
Curr Med Res Opin. 2009 Aug;25(8):2081-90. doi: 10.1185/03007990903084800.
Angiogenesis inhibitors (AI) are promising novel treatments for patients with renal cell carcinoma (RCC). However, IV therapy may impose infection risk from IV catheters, and will include increased costs due to administration and transportation costs. This study evaluated the incremental costs associated with IV administration of selected AI therapies (bevacizumab off-label) compared to oral therapies (sunitinib or sorafenib) for the treatment of RCC.
Patients with > or =2 RCC claims (ICD-9: 189.0, 198.0) were identified from a US commercial health insurance claims database from 1/2004 to 12/2007. Patients receiving bevacizumab (n = 109) were matched 1:1 to patients receiving sorafenib or sunitinib, and observed from their first AI therapy claim until the last treatment date. AI, inpatient, outpatient and pharmacy costs were calculated on a per-patient per-month (PPPM) basis over the treatment period. Costs were compared between the IV AI group and each separate oral AI group using multivariate Tobit regressions for each category separately, adjusting for demographic and baseline clinical characteristics. This study assessed costs of treatment and did not evaluate the cost-effectiveness of AIs.
Mean total medical costs were $13,351, $6998, and $8213 PPPM for bevacizumab, sorafenib, and sunitinib, respectively (p <0.05 for equality). Adjusted incremental total cost for the bevacizumab group was $4951 PPPM compared to sorafenib and $4610 PPPM compared to sunitinib (both p < 0.05). Bevacizumab patients incurred incremental PPPM outpatient services cost compared to sorafenib and sunitinib of $2772 and $2548, respectively (both p < 0.05).
Assuming median progression-free survival of 8.5 months as shown for bevacizumab (Bukowski, et al., J Clin Oncol 2007), the incremental costs would be estimated at $39 188-42 080 per patient compared to those treated with sunitinib or sorafenib. Assuming similar efficacies, oral AI therapies may result in cost savings to patients and healthcare payers over IV therapies.
血管生成抑制剂（AI）是治疗肾细胞癌（RCC）患者的一种有前景的新型疗法。然而，静脉注射疗法可能因静脉导管带来感染风险，且由于给药和运输成本，费用会增加。本研究评估了与静脉注射选定的AI疗法（贝伐单抗的非标签使用）相比，口服疗法（舒尼替尼或索拉非尼）治疗RCC的增量成本。
从2004年1月至2007年12月的美国商业健康保险理赔数据库中识别出有≥2次RCC理赔记录（国际疾病分类第九版：189.0、198.0）的患者。接受贝伐单抗治疗的患者（n = 109）与接受索拉非尼或舒尼替尼治疗的患者进行1:1匹配，并从他们首次提出AI治疗理赔开始观察至最后治疗日期。在治疗期间，按每位患者每月（PPPM）计算AI、住院、门诊和药房费用。使用多变量Tobit回归分别对每个类别比较静脉注射AI组与每个单独的口服AI组之间的费用，并对人口统计学和基线临床特征进行调整。本研究评估了治疗费用，未评估AI的成本效益。
贝伐单抗、索拉非尼和舒尼替尼的平均总医疗费用分别为每患者每月13351美元、6998美元和8213美元（相等性检验p <0.05）。与索拉非尼相比，贝伐单抗组调整后的增量总成本为每患者每月4951美元，与舒尼替尼相比为每患者每月4610美元（均p <0.05）。与索拉非尼和舒尼替尼相比，贝伐单抗治疗的患者门诊服务增量成本分别为每患者每月2772美元和2548美元（均p <0.05）。
假设贝伐单抗的无进展生存期中位数为8.5个月（布科夫斯基等人，《临床肿瘤学杂志》2007年），与接受舒尼替尼或索拉非尼治疗的患者相比，每位患者的增量成本估计为39188 - 42080美元。假设疗效相似，口服AI疗法可能会为患者和医疗保健支付方节省成本，相比静脉注射疗法。
