Estimated direct costs of renal cancer by stage and care phase: a whole disease modeljuj

Abstract

Abstract Background Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which include costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines. Methods Considering the clinical pathway for RCC adopted in the Veneto region (north-east Italy) and the latest guidelines, we developed a very detailed “whole-disease” model that covers the probabilities of all potentially necessary diagnostic and therapeutic action involved in the management of RCC. Based on the cost of each procedure according to the Veneto Regional Authority's official reimbursement tariffs, we estimated the total and average per-patient costs by stage of disease (early or advanced) and phase of its management. Results In the first year after diagnosis, the mean expected cost of a patient with RCC is €12,991 if it is localized or locally-advanced, and reaches €40,586 if it is advanced. For early disease, the main cost is incurred by surgery, whereas medical therapy (first and second line) and supportive care become increasingly important for metastatic disease. Conclusions It is crucially important to examine the direct costs of care for RCC, and to predict the burden on healthcare services of new oncological therapies and treatments, as the findings could be useful for policy-makers planning the allocation of resources. Key messages An estimation of the direct costs of renal cell carcinoma, and in general for cancer, appears fundamental to predict the burden of new oncological therapies and treatments on healthcare services. Our model could represent a useful tool for policy-makers in the optimization of resources allocation, especially in a time of budget constraints.