Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Pharmacoeconomics. 2011 Apr;29(4):331-41. doi: 10.2165/11586110-000000000-00000.
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.
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 SEER-Medicare 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 MarketScan CCAE database.
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 10,683, 11,655) 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 $US31,000-65,000 higher for RCC patients treated with targeted therapies, with the largest increase observed among the non-elderly patients.
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.
当英国国家卫生与临床优化研究所（NICE）拒绝为转移性肾细胞癌（RCC）患者提供舒尼替尼的医保覆盖（后来又被推翻）时，RCC 的经济负担问题引起了广泛关注。在对 RCC 相关经济学研究进行了最新的评估后，我们补充了文献中报告的 RCC 成本估算，并根据最新的美国数据库估算了几种新批准的靶向药物的使用情况。
我们使用了 1991-2007 年 SEER（监测、流行病学和最终结果）-医疗保险和 1996-2007 年市场扫描商业索赔和遭遇（CCAE）和医疗保险补充数据库进行分析，并根据每个数据库构建的 RCC 或肾癌的现患队列来估算 RCC 的费用。所有成本估算均以 2009 年美元计价。采用增量成本法，根据 2005 年 SEER-医疗保险数据库中确定的 RCC 现患队列，估算各治疗阶段 RCC 的年度成本。我们使用扩展估计方程方法来估算接受靶向治疗的患者对 RCC 年度成本的影响，同时控制患者年龄、性别、肿瘤特征、合并症和地理位置等混杂因素。该方法应用于从 SEER-医疗保险数据库和市场扫描医疗保险补充数据库中确定的两个老年 RCC 患者队列以及从市场扫描 CCAE 数据库中确定的非老年 RCC 患者队列。
根据我们对最新 SEER-医疗保险数据的分析，与匹配样本中治疗老年非癌症患者的成本相比，治疗老年 RCC 患者的平均年成本增加了 11169 美元（95%CI：10683 美元，11655 美元）。接受靶向治疗的 RCC 患者的年度治疗费用是接受其他治疗的患者的 3-4 倍。多变量分析结果表明，在控制潜在混杂因素后，接受靶向治疗的 RCC 患者的年度医疗费用增加了 31000-65000 美元，其中非老年患者的增幅最大。
随着靶向治疗的广泛应用，RCC 的经济负担可能会增加。需要进一步研究了解各种因素对 RCC 经济负担的影响，如疾病发病率增加、微创外科技术的使用以及新兴靶向治疗的更广泛应用。
