Costs of Episodes of Care in mRCC

Costs of episodes of care in metastatic renal cell carcinoma (mRCC) vary by therapy and treatment decisions have financial implications. Due to a shift in reimbursement from traditional fee-for-service models toward episode-based care, the value of therapies can be examined. Anne Kangethe, PharmD, MPH, PhD, and colleagues conducted a retrospective analysis to determine episode-based total cost, including medical and pharmacy costs, and resource utilization by therapy for patients with mRCC.

The researchers utilized the Oncology Care Model methodology for the assessment. Results of the study were reported during a poster session at the 2019 ASCO Quality Care Symposium in a poster titled Exploratory Analysis of the Cost of Episodes of Care in Metastatic Renal Cell Carcinoma in the United States.

The analysis included commercial claims data incurred between January 1, 2013, and June 30, 2018. Inclusion criteria were 18 years of age on the index date, one or more claims with a diagnosis code of RCC, two or more claims for metastasis on or after the initial date of RCC diagnosis, evidence of any mRCC systemic therapy on or after the initial date of mRCC diagnosis, and continuous enrollment form six or more months before until six or more months after the index date. Patients were classified by one of six therapy classes: tyrosine kinase inhibitors (TKIs) monotherapy, mechanistic target of rapamycin (mTOR) monotherapy, immune-oncology (IO) monotherapy, other (e.g., interferon) monotherapy, changed therapy class (e.g., from TKI to mTOR), or traditional chemotherapy.

The analysis included data on 606 eligible commercially insured patients. Most received monotherapy and 53% had two or more episodes of care: two or more episodes of care occurred in 59% of patents in the TKI group, 17% of those in the mTOR group, 28% of the IO group, 59% of those in the other category, 85% of the changed therapy class, and 38% of chemotherapy patients.

Patients in the IO group had the longest inpatient length of stay per episode (7 days; P=.0002).

There were differences in total episode costs among each therapeutic class: TKI (n=161; $61,417), mTOR (n=30; $67,637), IO (n=75; $92,082); other (n=34; $98,877), changed therapy (n=130, $84,480), and chemotherapy (n=34; $55,743), P<.0001.

In summary, the researchers said, “Differences in total episode costs exist in each monotherapy class used to treat mRCC, even in an episode-based structure. As healthcare financing shifts to alternative payment models, it is important to investigate overall episode cost of care for various therapies, as the cost for the individual drug may not accurately reflect the total episode value.”

Source: Kangethe A, Polson M, Speicher LC, et al. Exploratory analysis of the cost of episodes of care in metastatic renal cell carcinoma in the United States. Abstract of a poster presented at the 2019 American Society of Clinical Oncology Quality Care Symposium, September 6, 2019, San Diego, California.