Section of Medical Oncology, Internal Medicine Department, Yale School of Medicine, New Haven, CT, USA.
Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT, USA.
JNCI Cancer Spectr. 2024 Sep 2;8(5). doi: 10.1093/jncics/pkae067.
Immunotherapy (IO) and oral anticancer agents (OAA) have improved outcomes for metastatic renal cell carcinoma (mRCC), but there is a need to understand real-world costs from the perspective of payers and patients.
We used retrospective fee-for-service Medicare 100% claims data to study patients diagnosed with mRCC in 2015-2019. We identified initial treatment type and costs (the year after diagnosis) and analyzed differences in monthly and 12-month costs over time and between OAA, IO, and combination groups and the association between Out-Of-Pocket (OOP) costs and adherence.
We identified 15 407 patients with mRCC (61% male; 85% non-Hispanic White). A total of 6196 received OAA, IO, or combination OAA/IO as initial treatment. OAA use decreased (from 31% to 11%) with a simultaneous rise in patients receiving IO (3% to 26%) or combination IO/OAA therapy (1% to 11%). Medicare payments for all patients with mRCC increased by 41%, from $60 320 (95% confidence interval = 58 260 to 62 380) in 2015 to $85 130 (95% confidence interval = 82 630 to 87 630) in 2019. Payments increased in patients who received OAA, IO, or combination OAA/IO but were stable in those with other/no treatment. Initial higher OOP responsibility ($200-$1000) was associated with 13% decrease in percent days covered in patients receiving OAA in the first 90 days of treatment, compared with those whose OOP responsibility was less than $200.
From 2015 to 2019, costs for Medicare patients with mRCC rose substantially due to more patients receiving IO or IO/OAA combined therapy and increases in costs among those receiving those therapies. Increased OOP costs was associated with decreased adherence.
免疫疗法（IO）和口服抗癌药物（OAA）改善了转移性肾细胞癌（mRCC）患者的预后，但需要从支付者和患者的角度了解实际成本。
我们使用回顾性的 100%医疗保险费用数据研究了 2015 年至 2019 年期间被诊断为 mRCC 的患者。我们确定了初始治疗类型和费用（诊断后一年），并分析了随时间推移和 OAA、IO 和联合治疗组之间的月度和 12 个月费用差异，以及自付费用（OOP）与依从性之间的关系。
我们确定了 15407 例 mRCC 患者（61%为男性；85%为非西班牙裔白人）。共有 6196 例患者接受了 OAA、IO 或联合 OAA/IO 作为初始治疗。OAA 的使用（从 31%降至 11%）与接受 IO（从 3%升至 26%）或联合 IO/OAA 治疗（从 1%升至 11%）的患者数量同时增加。所有 mRCC 患者的医疗保险支付增加了 41%，从 2015 年的 60320 美元（95%置信区间=58260 美元至 62380 美元）增加到 2019 年的 85130 美元（95%置信区间=82630 美元至 87630 美元）。接受 OAA、IO 或联合 OAA/IO 治疗的患者的支付增加，但接受其他/无治疗的患者的支付保持稳定。与 OOP 责任低于 200 美元的患者相比，在接受 OAA 治疗的最初 90 天内，OOP 责任较高（200-1000 美元）的患者，其覆盖率百分比降低了 13%。
从 2015 年到 2019 年，由于更多的患者接受 IO 或 IO/OAA 联合治疗，以及接受这些治疗的患者的成本增加，mRCC 患者的医疗保险成本大幅上升。OOP 成本的增加与依从性的降低有关。
