title: In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013.
abstract: OBJECTIVE
  The aim of this study was to assess the economic burden of hospitalisations for metastatic renal cell carcinoma (mRCC), to describe the patterns of prescribing expensive drugs and to explore the impact of geographic and socio-demographic factors on the use of these drugs.
  
  
  METHODS
  We performed a retrospective analysis from the French national hospitals database. Hospital stays for mRCC between 2008 and 2013 were identified by combining the 10th revision of the International Classification of Diseases (ICD-10) codes for renal cell carcinoma (C64) and codes for metastases (C77 to C79). Incident cases were identified out of all hospital stays and followed till December 2013. Descriptive analyses were performed with a focus on hospital stays and patient characteristics. Costs were assessed from the perspective of the French National Health Insurance and were obtained from official diagnosis-related group tariffs for public and private hospitals.
  
  
  RESULTS
  A total of 15,752 adult patients were hospitalised for mRCC, corresponding to 102,613 hospital stays. Of those patients, 68% were men and the median age at first hospitalisation was 69 years [Min-Max: 18-102]. Over the study period, the hospital mortality rate reached 37%. The annual cost of managing mRCC at hospital varied between 28M€ in 2008 and 42M€ in 2012 and was mainly driven by inpatient costs. The mean annual per capita cost of hospital management of mRCC varied across the study period from 8,993€ (SD: €8,906) in 2008 to 10,216€ (SD: €10,527) in 2012. Analysis of the determinants of prescribing expensive drugs at hospital did not show social or territorial differences in the use of these drugs.
  
  
  CONCLUSIONS
  This study is the first to investigate the in-hospital economic burden of mRCC in France. Results showed that in-hospital costs of managing mRCC are mainly driven by expensive drugs and inpatient costs.
authors.affiliation: GlaxoSmithKline, Marly le Roi, France.|ECEVE, Inserm, Paris, France.
authors.forename: Rana
authors.identifier: http://orcid.org/0000-0002-6592-5739
authors.initials: R
authors.lastname: Maroun
authors.affiliation: Statesia, Le Mans, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Maunoury
authors.affiliation: GlaxoSmithKline, Marly le Roi, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Benjamin
authors.affiliation: GlaxoSmithKline, Marly le Roi, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Nachbaur
authors.affiliation: URC Eco Ile-de-France, AP-HP, Paris, France.|ECEVE, Inserm, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000401:mortality / Q000628:therapy*; D017281:Cost of Illness; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005602:France; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D038801:International Classification of Diseases; D007680:Kidney Neoplasms / Q000145:classification / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult