Real-world costs and outcomes in metastatic renal cell carcinoma patients treated with targeted therapies: a cohort study from the French health insurance database

Abstract

Objectives: The objective of this study was to describe treatment patterns, survival, healthcare use and costs in patients with metastatic renal cell carcinoma (mRCC) in a real-world setting.

Research design and methods: We used the National Health Insurance (NHI) claims database for the Ile-de-France region to perform a retrospective cohort analysis of patients with mRCC treated by a first-line targeted therapy. Treatment naïve patients were identified combining the 10th revision of the International Classification of Diseases (ICD-10) codes (C64 & C77-C79) and a first prescription of targeted therapies. Descriptive analyses were performed on treatment patterns and patients’ characteristics. Progression free survival (PFS) and overall survival (OS) were determined using Kaplan–Meier actuarial survival analysis. All healthcare resource use and costs were estimated on a per patient per month (PPPM) basis (€2016).

Results: A total of 327 treatment naïve patients with mRCC were included. Median follow-up was 13.4 months. Sunitinib accounted for 73% of first-line treatments. The most frequently observed treatment sequence for the first two lines was sunitinib–everolimus (16%; n = 137) and for the first three lines sunitinib–everolimus–axitinib (20%; n = 49). First-line PFS for sunitinib, everolimus, pazopanib, sorafenib and other was 8.7, 6.2, 10.7, 5.7 and 11.2 months, respectively. Median OS for patients treated by first-line sunitinib, everolimus, pazopanib, sorafenib and other was respectively 14.7, 8.1, 21.1, 8.9 and 14.0 months. From the NHI’s perspective, the mean PPPM was €5546. The average PPPM in pre-progression was €5597 compared to €5541 beyond progression of the disease. Oral targeted therapies accounted for 53% of the total PPPM.

Conclusion: This descriptive study showed that the economic burden of mRCC is substantial with oral targeted therapies accounting for 53% of the PPPM. OS and PFS in real life are poorer than observed in clinical trials.

Keywords:

• Kidney cancer
• real-world data
• care pathways
• cost of illness
• targeted therapies

Transparency

Declaration of funding

This work is part of a PhD program supported by GlaxoSmithKline (GSK) and the Association Nationale de la Recherche et de la Technologie (ANRT).

Declaration of financial/other relationships

R.M. and G.N. have disclosed that they are employees of GlaxoSmithKline (GSK). G.N. has disclosed that she hold stock options from GSK. F.M. has disclosed that he is the CEO of Statesia, a consultancy firm who previously worked for GSK, but with regard to this study did not receive any funding from GSK. I.D.Z. has disclosed that she is an employee of the public hospitals of Paris and has participated in advisory boards for the pharmaceutical industry including GSK, but with regard to this study did not receive any funding from GSK. L.F. and J.L.V. have disclosed that they are employees of DRSM Ile de France (Health Insurance for Ile de France Region).

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Antoine Perrucci for his help with the presentation of the results.