Texas Oncology PA, 6204 Balcones Dr., Austin, TX, 78731, USA.
Aveo Oncology, 30 Winter St., Boston, MA, 02108, USA.
BMC Health Serv Res. 2024 Oct 25;24(1):1283. doi: 10.1186/s12913-024-11587-8.
The majority of metastatic renal cell carcinoma (mRCC) patients receive one or more VEGFR TKI agents, alone or in combination with an immune-oncology (IO) agent or an mTOR inhibitor. To date, the cost of adverse events (AEs) common to VEGFR TKIs has not been quantified. This study estimated the potential impact of differences in VEGFR TKI AE profiles on treatment cost efficiency in the relapsed/refractory (R/R) setting.
Patients with documented mRCC who were treated with VEGFR TKI therapies between Jan 2015 and Mar 2021 were identified using EMR. ICD-10 diagnosis codes were used to identify the first occurrence of each class effect AE. Patients were matched to 3rd party insurance claims, and costs associated to TKI AEs within 90 days of index event were captured. Average per patient AE cost data was calculated and applied to published incidence data to estimate regimen-specific AE total cost burden within a hypothetical commercial plan for mRCC patients undergoing treatment in the R/R setting.
The highest total cost for AE management was attributed to lenvatinib and everolimus use at $13,303, followed closely by sunitinib at $13,092. Tivozanib treatment was associated with the lowest total cost of AE management at $7,523, driven by the relatively lower incidence of certain high-cost AEs.
The estimated costs of managing VEGFR TKI class-effect AEs were lowest with tivozanib, and highest with lenvatinib and everolimus, indicating potentially differential healthcare resource burden by TKI regimen. The use of tivozanib in the 3 L + mRCC setting suggests potential costs offsets when compared to other TKI regimens.
大多数转移性肾细胞癌（mRCC）患者接受一种或多种血管内皮生长因子受体酪氨酸激酶抑制剂（VEGFR TKI）治疗，单独或联合免疫肿瘤学（IO）药物或 mTOR 抑制剂。迄今为止，尚未对 VEGFR TKI 常见不良反应（AE）的成本进行量化。本研究旨在评估 VEGFR TKI AE 谱差异对复发/难治性（R/R）环境下治疗成本效益的潜在影响。
使用电子病历（EMR）识别 2015 年 1 月至 2021 年 3 月期间接受 VEGFR TKI 治疗的有记录的 mRCC 患者。ICD-10 诊断代码用于识别每种类效应 AE 的首次发生。对患者进行第三方保险索赔匹配，并捕获索引事件后 90 天内与 TKI AE 相关的费用。计算每位患者 AE 成本的平均值，并应用于已发表的发病率数据，以估算 R/R 环境下接受治疗的 mRCC 患者假设商业计划中特定方案的 AE 总成本负担。
AE 管理的总费用最高归因于 lenvatinib 和 everolimus 的使用，为 13303 美元，紧随其后的是 sunitinib，为 13092 美元。Tivozanib 治疗与 AE 管理的总成本最低相关，为 7523 美元，这主要是由于某些高成本 AE 的相对较低发生率。
tivozanib 管理 VEGFR TKI 类效应 AE 的估计成本最低，而 lenvatinib 和 everolimus 最高，这表明 TKI 方案的潜在差异对医疗资源的负担。与其他 TKI 方案相比，在 3L+mRCC 环境中使用 tivozanib 可能会降低成本。
