Observational study evaluating resource utilization among metastatic renal cell carcinoma patients treated with mTOR inhibitors in the outpatient community-based setting.

Abstract

e15027 Background: Everolimus (E), an oral mTOR inhibitor, was approved by the FDA on 3/30/2009 for the treatment of advanced renal cell carcinoma (RCC). The purpose of this retrospective study was to evaluate outpatient resource utilization associated with E relative to temsirolimus (T), an intravenous mTOR inhibitor indicated for advanced RCC. Methods: Using US Oncology's (USO) iKnowMed EMR data, we identified metastatic RCC patients (pts) who initiated a regimen of E or T from 4/1/2009 – 7/31/2009. Claims for services incurred within the USO network were used in conjunction with pharmacy data from USO's pharmacies to estimate outpatient costs and resource utilization (frequency of outpatient visits, inpatient visits, and laboratory procedures). Costs for T were based on Medicare reimbursement rates, while costs for E were based on wholesale acquisition costs. Pts were followed through 11/30/2009 to estimate outpatient costs and resource utilization as calculated using a per patient-month (PPM) metric. Results: 107 pts were identified – 40 received E and 67 received T. Median age of pts was 66 (range: 23 – 86) and 65% were male. By payer status, 54% of pts were Medicare; 38% were Private; and 8% were Medicaid/self-pay/etc. Total costs PPM were similar between pts receiving E (mean = $5,913; median=$5,660) vs. T (mean = $5,767; median=$6,156) (p=0.62). Pts receiving E had significantly fewer outpatient visits per month vs. pts receiving T (mean/median = 1.69/1.60 vs. 4.0/3.8 visits per month; p<0.001) and also underwent fewer laboratory procedures (mean/median = 2.9/2.2 vs. 5.5/5.6 procedures per month; p<0.001). No statistically significant differences in inpatient admission rates were observed between pts receiving E vs. T (27% of E pts had inpatient visits vs. 28% of T pts, p=0.94). Conclusions: It is becoming increasingly important to weigh the relative costs and benefits of oral vs. intravenous therapies from multiple perspectives. Results of this preliminary observational study suggest that direct costs were similar between E and T; however, E was associated with lower patient burden in terms of outpatient and laboratory visits relative to T. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Novartis Novartis Novartis Novartis Novartis