title: Health economic changes as a result of implementation of targeted therapy for metastatic renal cell carcinoma: national results from DARENCA study 2.
abstract: BACKGROUND
  Limited data exist on the economic consequences of implementing targeted therapy (TT) for metastatic renal cell carcinoma (RCC) in a real-world setting.
  
  
  OBJECTIVE
  To analyze health care and productivity costs for TT implementation in a national cohort of patients.
  
  
  METHODS
  Costs were measured per patient per year during a 2-yr follow-up during 2002-2005 (immunotherapy only) and 2006-2009 (TT implementation). All Danish patients with a diagnosis code for RCC and a procedure code for TT or immunotherapy were linked to the Danish National Patient Registry (contains information on all contacts with primary and secondary health sector). Health care and productivity costs were retrieved from the Danish case-mix system and Coherent Social Statistics, respectively. Drug costs were calculated separately from procedure codes and retail prices.
  
  
  METHODS
  Generalized linear models were used to analyze costs adjusted for age, gender, and civil status.
  
  
  CONCLUSIONS
  A total of 439 patients were included for 2006-2009 and 192 for 2002-2005. Comparison of the health care cost per patient per year between 2006-2009 and 2002-2005 revealed lower inpatient costs (€11 899 vs €19 944, adjusted relative risk [RR] 0.64), higher outpatient costs (€14 308 vs €6209, RR 2.39), lower radiotherapy costs (€194 vs €633, RR 0.31), higher radiology costs (€676 vs €191, RR 3.73), and higher separately calculated drug costs (€12 040 vs €3103, RR 3.82, all p<0.001) for the former. Total health care costs per patient per year did not significantly differ (€27 676 vs €27 856, RR 1.05, p=0.5) between the two periods. Income from employment did not significantly differ between 2006-2009 and 2002-2005 (RR 1.11, p=0.11) and costs associated with loss of productivity were €7852 and €8265, respectively.
  
  
  CONCLUSIONS
  A different pattern of health care costs were observed but total health care costs per patient per year did not significantly differ after implementation of TT for patients with mRCC.
  
  
  RESULTS
  In this nationwide study, we found changes in the pattern of health care costs for patients with metastatic kidney cancer after implementation of targeted therapy compared to an immunotherapy control period; however, total health care costs and income from employment were without significant changes.
authors.affiliation: Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark. Electronic address: anne.vest.soerensen@regionh.dk.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Soerensen
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Frede
authors.initials: F
authors.lastname: Donskov
authors.affiliation: Danish Institute for Local and Regional Government Research (KORA), Copenhagen, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Kjellberg
authors.affiliation: i2Minds, Aarhus, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Ibsen
authors.affiliation: Department of Urology, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.
authors.forename: Gregers G
authors.initials: GG
authors.lastname: Hermann
authors.affiliation: Department of Oncology, Odense University Hospital, Odense, Denmark.
authors.forename: Niels V
authors.initials: NV
authors.lastname: Jensen
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Fode
authors.affiliation: Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Poul F
authors.initials: PF
authors.lastname: Geertsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D020533:Angiogenesis Inhibitors / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab / Q000191:economics / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D003365:Costs and Cost Analysis; D003718:Denmark; D016527:Drug Costs; D004526:Efficiency; D004651:Employment / Q000191:economics; D000068338:Everolimus / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use; D007211:Indoles / Q000191:economics / Q000627:therapeutic use; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D007376:Interleukin-2 / Q000191:economics / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy; D009536:Niacinamide / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000191:economics / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D011758:Pyrroles / Q000191:economics / Q000627:therapeutic use; D011859:Radiography / Q000191:economics; D011878:Radiotherapy / Q000191:economics; D012042:Registries; D020123:Sirolimus / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000077157:Sorafenib; D000077210:Sunitinib
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D007155:Immunologic Factors; D007211:Indoles; D016898:Interferon-alpha; D007376:Interleukin-2; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D009536:Niacinamide; D000068258:Bevacizumab; C401859:temsirolimus; D000068338:Everolimus; D000077157:Sorafenib; D005472:Fluorouracil; D000077210:Sunitinib; D020123:Sirolimus
keywords: Cost analysis; Economic analysis; Implementation; Metastatic renal cell carcinoma; National; Observational; Population-based; Targeted therapy