PCN189 RENAL CELL CANCER IN CHILE: STUDYING THE EFFECTS OF FINANCIAL-RISK POOLING TO FACILITATE COVERAGE DECISIONS.

Abstract

Renal Cell Cancer (RCC) represents 90% of malignant renal tumors. In Chile, drugs for advanced RCC are not covered by private insurers, chemotherapy is not a standard treatment, and out-of-pocket expenditure is common in patients who can afford expensive therapies. This study aims to identify treatment costs of RCC from Early to Late Stages (ES and LS) and to estimate the costs of including innovative therapies in LS for the population of a private insurer. A comprehensive direct-costs study focused on ES and LS, and the estimation of incorporating innovation drugs for LS was carried-out. International recommendations were retrieved and validated by local expert; local epidemiology, sub-groups per-stage, histological classification were examined. By designing clinical pathways, costs-drivers were identified, quantified and cost. For LS RCC, nephrectomy, tyrosine-kinase inhibitors and immunomodulators were included as alternatives. Seventeen cases were found in LS; 30% in ES, 75% in 0-1 ECOG status, and 85% present clear-cells histology. Current ES cost-per-month distributed among all ES and LS “Confirmed Cases” (CC) without drugs-treatment is U$D187 per-case, whereas for LS is U$D166 USD. For ECOG 0-1 susceptible of receiving first-line (1L) adjuvant therapies, a cost of U$D1,008 per-month per-case distributed among all CC was found; 54% out of them, could be eligible for second-line (2L) treatments at U$D1,516 per-month each distributed among CC. Incremental cost of LS, 1L, and 2L is U$D3,799 distributed among LS cases (regular procedure in local insurances); Instead, incremental cost distributed among all CC decreases until U$D2,691 (29,16% decrease). A cumulative incremental cost of 0.7 times per-month could help to gain access to high-cost medicines in LS RCC by pooling financial risk among ES and LS. This is crucial in insurance functioning. By pooling financial risk among extensive cohorts (ES and LS, and not only among LS), incremental total costs decrease in 42%.