title: Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States.
abstract: BACKGROUND
  To evaluate the evolution of treatment patterns and associated costs for metastatic renal cell carcinoma (mRCC) in the United States.
  
  
  METHODS
  The LifeLink Health Plan Claims Database was used to create a cohort of mRCC patients with at least 12 months of continuous enrollment from 2004 to 2011. We summarized treatment patterns over time; we used a nonparametric bootstrapping method to compare costs and logistic regression to examine the association between the likelihood of advancing to third-line therapy and beyond and the number of targeted therapy agents available.
  
  
  RESULTS
  A total of 1527 mRCC patients were analyzed. In 2010, nine unique treatment regimens were used for first-line treatment, 8 for second-line treatment, and 8 for third-line treatment. A significant association (odds ratio 1.26; P = .001) between the odds of advancing to third-line therapy or beyond and the number of targeted agents available was noted. For 767 patients receiving modern therapy who were < 65 years old, and stratifying by whether the first-line treatment was oral or intravenous, drug cost per patient with ancillary services was $59,664 versus $86,518, respectively (P = .001). Total costs and drug out-of-pocket costs per patient during the first year increased by the number of switches: $111,680 to $2355 for no switches, $149,994 to $2538 for 1 switch, and $196,706 to $3524 for 2 or more switches. In 2004, the median drug cost was $11,458, while by 2010 it rose to $68,660.
  
  
  CONCLUSIONS
  A marked shift in the management of mRCC has occurred, with wide heterogeneity in treatment patterns. More patients are able to receive more lines of therapy, but treatment costs are high.
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Geynisman
authors.affiliation: Department of Urology, UCLA Medical Center, Los Angeles, CA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, IL.
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL. Electronic address: tshih@bsd.uchicago.edu.
authors.forename: Ya-Chen
authors.initials: YC
authors.lastname: Tina Shih
mesh_terms: D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D016527:Drug Costs; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics*; D016015:Logistic Models; D008297:Male; D009362:Neoplasm Metastasis
keywords: Antineoplastic agents; Drug costs; Oral anticancer medications; Renal cell carcinoma; Treatment patterns