Abstract
e16521 Background: Authors have shown that 1st-year medical costs of SR were less than SU in initial treatment of RCC pts and that baseline comorbidities were similar. Case series data suggest RCC control is common when either SR or SU is used sequentially. We investigated direct medical costs associated with each sequence. Methods: We conducted a retrospective U.S. claims-based analysis using MarketScan covering all U.S. census regions and >18 million lives annually from 2002 to 2009. Pts with ≥2 RCC claims (ICD9 189.0 and 198.0), continuous health care coverage, ≥1 switch from SR to SU or SU to SR, and >180 days' coverage before switch date were included. Observation period began with 1st-line therapy ≤12 mo before switch and ended ≤12 mo after switch. Second-line therapy (switch) ended with next dispensing of SR, SU, bevacizumab, or temsirolimus; disenrollment; death; or study end (3/31/09). A person-time approach was used. Limitations include physician coding and lack of disease staging. Results: At time of switch, the only significant differences between SU>SR (n=153) and SR>SU (n=119) groups were longer health plan enrolment in SR>SU group (12.4 vs 8.8 mo; p<0.0001) and higher prevalence of anemia in SU>SR group (52.9% vs 32.8%, p<0.001). Demographics, prior tumor removal, and/or shrinkage procedures were similar between groups. Univariate incremental total per member per month (PMPM) medical cost for SU>SR pts was $1639 (p=0.0003) more than SR>SU pts, representing yearly cost savings of $19,668 in RCC pts initially treated with SR. Conclusions: This retrospective claims database analysis suggests statistically significantly lower costs in RCC pts initially treated with SR, the difference mainly attributable to outpatient costs. These data mandate cost analyses as part of prospective trials of sequencing in RCC. Univariate analysis from ≤12 mo of 1st-line therapy to ≤12 mo of 2nd-line therapy Mean weighted costs PMPM, $ SU>SR SR>SU Incremental cost of receiving SU first P value Total medical cost 9,159 7,520 1,639 0.0003 Outpatient 3,400 2,148 1,252 <0.0001 Inpatient 1,755 1,582 173 0.6179 Pharmacy 4,004 3,790 214 0.1077 Pt-mo (n) 1,571 1,730 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bayer Bayer, Genentech, GlaxoSmithKline, Novartis, Pfizer, Roche Bayer Bayer, Genentech, GlaxoSmithKline, Novartis, Pfizer, Roche Bayer, Genentech
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