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

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.

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 10(th) 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 using per patient per month (PPPM) basis (€2016).

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 €5,546. The average PPPM in pre-progression was €5,597 as compared to €5,541 beyond progression of the disease. Oral targeted therapies accounted for 53% of the total PPPM.

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.

Current medical research and opinion. 2017 Jul 27 [Epub ahead of print]

Rana Maroun, Laetitia Fleury, Gaelle Nachbaur, Franck Maunoury, Jean-Louis Vanhille, Isabelle Durand-Zaleski

a GlaxoSmithKline, Health Outcomes Research , Marly le Roi , France., c DRSM Ile de France , Paris , France., d Statesia , Le Mans , France., b INSERM, ECEVE, UMR 1123 , Paris , France.