Metastatic renal cancer: real-world evidence from a large Italian claims database
Keywords:Big Data, Health Care Costs, Italian National Health Service, Public Health Practice, Renal Neoplasms
Purpose: To assess the healthcare resources’ consumption and integrated costs of patients with renal cancer and new metastasis (mRCC), in the perspective of the Italian National Health System (NHS).
Methods: From the ReS database, through the administrative data record linkage, adults with a primary/secondary hospital (ordinary/daily admissions) diagnosis (ICD9-CM code) of renal cancer and lymph node and/or distant metastases in the same hospital discharge (index date) were selected in 2015. Metastases were defined new if they were absent in the 2 previous years. Patients were described in terms of gender, age (mean ± SD) and comorbidities of interest. The 2-year survival and annual pharmacological treatments, hospitalization, outpatient specialist services and costs were analysed.
Results: Out of >6 million adults in the 2015 ReS database, 133 (2.1 × 100,000) were hospitalized with a diagnosis of RCC and metastasis. Patients with new metastases were 63.2% (1.4 × 100,000; 73.8% males; mean age 68 ± 13). Hypertension was the most common comorbidity (70.2% of mRCC patients). The 2-year survival of mRCC patients was 26.2%. During 1-year follow-up, at least a drug was prescribed to 88.1% of mRCC patients (on average € 12,095/patient), 91.7% were hospitalized (€ 8,897/patient) and 82.1% entrusted the outpatient specialist care (€ 1,075/patient). The mean overall expenditure for the NHS was € 22,067 per capita.
Conclusions: This study shows the mRCC burden on the Italian real clinical practice and its economic impact in the perspective of the NHS. Real-world analyses prove to be useful to concretely estimate the overall healthcare responsibility on patients affected by mRCC.
Porta C, D’Attino R. Epidemiologia e standard di cura attuale del carcinoma renale metastatico in Italia. Ital J Public Health. 2011;8(3)(suppl 2):S7-S16.
Ljungberg B, Campbell SC, Choi HY, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60(4):615-621. https://doi.org/10.1016/j.eururo.2011.06.049 PMID:21741761
Unverzagt S, Moldenhauer I, Nothacker M, et al. Immunotherapy for metastatic renal cell carcinoma. Cochrane Database Syst Rev. 2017;5(5):CD011673. PMID:28504837
Zerdes I, Tolia M, Tsoukalas N, et al. Systemic therapy of metastatic renal cell carcinoma: review of the current literature. Urologia. 2019;86(1):3-8. https://doi.org/10.1177/0391560318802166 PMID:30270773
Nazha S, Tanguay S, Kapoor A, et al. Use of targeted therapy in patients with metastatic renal cell carcinoma: clinical and economic impact in a Canadian real-life setting. Curr Oncol. 2018;25(6):e576-e584. https://doi.org/10.3747/co.25.4103 PMID:30607126
Goebell PJ, Staehler M, Müller L, et al; RCC-Registry Group (Tumour Registry of Advanced Renal Cell Carcinoma). Changes in Treatment Reality and Survival of Patients With Advanced Clear Cell Renal Cell Carcinoma - Analyses From the German Clinical RCC-Registry. Clin Genitourin Cancer. 2018;16(6):e1101-e1115. https://doi.org/10.1016/j.clgc.2018.06.006 PMID:30061035
de Groot S, Redekop WK, Versteegh MM, et al. Health-related quality of life and its determinants in patients with metastatic renal cell carcinoma. Qual Life Res. 2018;27(1):115-124. https://doi.org/10.1007/s11136-017-1704-4 PMID:28917029
Atkins MB, Tannir NM. Current and emerging therapies for first-line treatment of metastatic clear cell renal cell carcinoma. Cancer Treat Rev. 2018;70:127-137. https://doi.org/10.1016/j.ctrv.2018.07.009 PMID:30173085
Associazione Italiana di Oncologia Medica. Linee Guida. Tumori del rene. 2018. Online (https://www.aiom.it/linee-guida-aiom-2018-tumori-del-rene/)
Associazione Italiana dei Registri Tumori. I numeri del cancro in Italia. 2019. Online (https://www.aiom.it/wp-content/uploads/2019/09/2019_Numeri_Cancro-operatori-web.pdf)
Lipworth L, Morgans AK, Edwards TL, et al. Renal cell cancer histological subtype distribution differs by race and sex. BJU Int. 2016;117(2):260-265. https://doi.org/10.1111/bju.12950 PMID:25307281
Escudier B, Porta C, Schmidinger M, et al; ESMO Guidelines Committee. Electronic address: email@example.com. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019;30(5):706-720. https://doi.org/10.1093/annonc/mdz056 PMID:30788497
Manola J, Royston P, Elson P, et al; International Kidney Cancer Working Group. Prognostic model for survival in patients with metastatic renal cell carcinoma: results from the international kidney cancer working group. Clin Cancer Res. 2011;17(16):5443-5450. https://doi.org/10.1158/1078-0432.CCR-11-0553 PMID:21828239
Pal S, Gong J, Mhatre SK, et al. Real-world treatment patterns and adverse events in metastatic renal cell carcinoma from a large US claims database. BMC Cancer. 2019;19(1):548. https://doi.org/10.1186/s12885-019-5716-z PMID:31174493
Posadas EM, Limvorasak S, Figlin RA. Targeted therapies for renal cell carcinoma. Nat Rev Nephrol. 2017;13(8):496-511. https://doi.org/10.1038/nrneph.2017.82 PMID:28691713
Choueiri TK, Motzer RJ. Systemic Therapy for Metastatic Renal-Cell Carcinoma. N Engl J Med. 2017;376(4):354-366. https://doi.org/10.1056/NEJMra1601333 PMID:28121507
Network NCC. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Kidney Cancer. Version 1.2020-June 7, 2019. 2020. Online https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf
Dickman PW, Hakulinen T, Luostarinen T, et al. Survival of cancer patients in Finland 1955-1994. Acta Oncol. 1999;38(suppl 12):1-103. https://doi.org/10.1080/028418699432996 PMID:10225326
Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 1999;17(8):2530-2540. https://doi.org/10.1200/JCO.1918.104.22.1680 PMID:10561319
Tenold M, Ravi P, Kumar M, et al. Current Approaches to the Treatment of Advanced or Metastatic Renal Cell Carcinoma. Am Soc Clin Oncol Educ Book. 2020;40:1-10. https://doi.org/10.1200/EDBK_279881 PMID: 32239988
Dutcher JP, Flippot R, Fallah J, Escudier B. On the Shoulders of Giants: The Evolution of Renal Cell Carcinoma Treatment-Cytokines, Targeted Therapy, and Immunotherapy. Am Soc Clin Oncol Educ Book. 2020;40:1-18. https://doi.org/10.1200/EDBK_280817 PMID: 32243201
Calabria S, Forcesi E, Dondi L, Pedrini A, Maggioni AP, Martini N. Target Population of Non-deferrable Surgery and Uncontrolled Severe Bleeding Related to Dabigatran. Cardiovasc Drugs Ther. 2018;32(3):281-286. https://doi.org/10.1007/s10557-018-6801-2 PMID:29869189
Cimminiello C, Dondi L, Pedrini A, et al. Patterns of treatment with antiplatelet therapy after an acute coronary syndrome: data from a large database in a community setting. Eur J Prev Cardiol. 2019;26(8):836-846. https://doi.org/10.1177/2047487318814970 PMID:30477319
Piccinni C, Ronconi G, Calabria S, et al. Healthcare resources utilisation in primary progressive multiple sclerosis. Neurol Sci. 2018;39(7):1169-1174. https://doi.org/10.1007/s10072-018-3404-4 PMID:29637449
Collaborating Center for Drug Statistics Methodology (WHO). ATC/DDD Index 2020. Online (https://www.whocc.no/atc_ddd_index/)
Ministero del Lavoro, della Salute e delle Politiche Sociali. Classificazione delle malattie, dei traumatismi, degli interventi chirurgici e delle procedure dagnostiche e terapeutiche. Versione italiana dell’ICD9-CM. 2007. Online (http://www.salute.gov.it/imgs/C_17_pubblicazioni_2251_allegato.pdf)
Ministero del Lavoro, della Salute e delle Politiche Sociali. Nomenclatore prestazioni di assistenza specialistica ambulatoriale. Allegato 4. DPCM 12 gennaio 2017. 2017. Online (http://www.trovanorme.salute.gov.it/norme/renderPdf.spring?seriegu=SG&datagu=18/03/2017&redaz=17A02015&artp=4&art=1&subart=1&subart1=10&vers=1&prog=001)
Istituto Nazionale di Statistica, ISTAT. Resident population by age, sex and marital status. 2015. Online (http://demo.istat.it/index_e.html)
Edwards SJ, Wakefield V, Cain P, et al. Axitinib, cabozantinib, everolimus, nivolumab, sunitinib and best supportive care in previously treated renal cell carcinoma: a systematic review and economic evaluation. Health Technol Assess. 2018;22(6):1-278. https://doi.org/10.3310/hta22060 PMID:29393024
Boffa DJ, Mallin K, Herrin J, et al. Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals. JAMA Netw Open. 2020;3(5):e203942. https://doi.org/10.1001/jamanetworkopen.2020.3942 PMID:32453382
Agenzia Italiana del Farmaco. L'uso dei farmaci in Italia. Rapporto Nazionale Anno 2018 [The use of drugs in Italy. National Report Year 2018]. 2018. Online (https://www.aifa.gov.it/en/web/guest/-/rapporto-osmed-20-1)
Ljungberg B, Albiges L, Bensalah K, et al. EAU Renal Cell Carcinoma Guidelines 2020. Online (https://uroweb.org/guideline/renal-cell-carcinoma/)
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