Cost implications of IV versus oral anti-angiogenesis therapies in patients with advanced renal cell carcinoma: retrospective claims database analysis*

ABSTRACT

Objective: Angiogenesis inhibitors (AI) are promising novel treatments for patients with renal cell carcinoma (RCC). However, IV therapy may impose infection risk from IV catheters, and will include increased costs due to administration and transportation costs. This study evaluated the incremental costs associated with IV administration of selected AI therapies (bevacizumab off-label) compared to oral therapies (sunitinib or sorafenib) for the treatment of RCC.

Methods: Patients with ≥2 RCC claims (ICD-9: 189.0, 198.0) were identified from a US commercial health insurance claims database from 1/2004 to 12/2007. Patients receiving bevacizumab (n = 109) were matched 1:1 to patients receiving sorafenib or sunitinib, and observed from their first AI therapy claim until the last treatment date. AI, inpatient, outpatient and pharmacy costs were calculated on a per-patient per-month (PPPM) basis over the treatment period. Costs were compared between the IV AI group and each separate oral AI group using multivariate Tobit regressions for each category separately, adjusting for demographic and baseline clinical characteristics. This study assessed costs of treatment and did not evaluate the cost-effectiveness of AIs.

Results: Mean total medical costs were $13 351, $6998, and $8213 PPPM for bevacizumab, sorafenib, and sunitinib, respectively (p <0.05 for equality). Adjusted incremental total cost for the bevacizumab group was $4951 PPPM compared to sorafenib and $4610 PPPM compared to sunitinib (both p < 0.05). Bevacizumab patients incurred incremental PPPM outpatient services cost compared to sorafenib and sunitinib of $2772 and $2548, respectively (both p < 0.05).

Conclusions: Assuming median progression-free survival of 8.5 months as shown for bevacizumab (Bukowski, et al., J Clin Oncol 2007), the incremental costs would be estimated at $39 188–42 080 per patient compared to those treated with sunitinib or sorafenib. Assuming similar efficacies, oral AI therapies may result in cost savings to patients and healthcare payers over IV therapies.

Key words::

• Angiogenesis inhibitors
• Cost
• IV bevacizumab
• Renal cell carcinoma

Transparency

Declaration of funding

This research was sponsored by GlaxoSmithKline, Collegeville, PA, USA.

Declaration of financial/other relationships

M.S.D., E.D., A.A.F., L.A. and D.R. have disclosed that they are employees of Analysis Group, Inc., which has received research funds from GlaxoSmithKline. M.P.N. has disclosed that she is an employee of, and owns stock in, GlaxoSmithKline. W.K.O. has disclosed that he has received a consulting fee from Genentech and Analysis Group. T.C. has disclosed that he has consulted for Genentech, GlaxoSmithKline, Abbott, Pfizer, Novartis and Bayer/Onyx as well as Analysis Group.

All peer reviewers receive honoraria from CMRO for their review work. The peer reviewers have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors disclose no editorial assistance in the preparation of this manuscript.

Notes

*Data from this paper were presented in part at the 13th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research, May 6, 2008, in Toronto, Canada