title: The health care burden of skeletal related events in patients with renal cell carcinoma and bone metastasis.
abstract: OBJECTIVE
  We examined temporal trends in skeletal related events and associated charges in patients with renal cell carcinoma metastatic to bone. We also identified patient and hospital characteristics associated with skeletal related events and related mortality.
  
  
  METHODS
  Using the Nationwide Inpatient Sample we abstracted data on patients with renal cell carcinoma who were diagnosed with concomitant bone metastasis between 1998 and 2010. Patients who experienced a skeletal related event were identified and hospital charges were calculated. Multivariate regression models fitted with generalized estimating equations were used to examine predictors of skeletal related events and related in-hospital mortality.
  
  
  RESULTS
  Between 1998 and 2010 a weighted estimate of 144,889 renal cell carcinoma hospital visits of patients with bone metastasis was identified in the Nationwide Inpatient Sample, of which 20.8% involved a skeletal related event. In these cases from 1998 to 2010 the inflation adjusted mean yearly costs associated with hospital admission increased by 207% in 2013 United States dollars (estimated annual percent change 8.94%, p<0.001). Conversely, the rates of skeletal related events and skeletal related event associated mortality decreased significantly (estimated annual percent change -1.11% and -2.9%, respectively, each p<0.001).
  
  
  CONCLUSIONS
  The prevalence and in-hospital mortality of skeletal related event associated hospitalization for metastatic renal cell carcinoma is decreasing but such charges to health care in the United States are increasing at an alarming rate. These findings highlight the need for cost-effective treatment strategies to prevent or treat these morbid complications.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. Electronic address: carina.antczak@gmail.com.
authors.forename: Carina
authors.initials: C
authors.lastname: Antczak
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Vincent Q
authors.initials: VQ
authors.lastname: Trinh
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nandita
authors.initials: N
authors.lastname: Krishna
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D001859:Bone Neoplasms / Q000191:economics* / Q000556:secondary / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000191:economics* / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007680:Kidney Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States
keywords: bone and bones; carcinoma; hospital charges; kidney; neoplasm metastasis; renal cell