Abstract
Background
Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries.
New clinical pathways have been developed to deal with this tumor, which includes
costly drugs that pose an economic threat to the sustainability of healthcare services.
This study provides an estimate of the direct costs of care for patients with RCC
by stage of disease (early vs. advanced) at diagnosis, and disease management phase along the pathway recommended
by local and international guidelines.
Materials and Methods
Considering the clinical pathway for RCC adopted in the Veneto region (north-east
Italy) and the latest guidelines, we developed a very detailed “whole-disease” model
that covers the probabilities of all potentially necessary diagnostic and therapeutic
actions involved in the management of RCC. Based on the cost of each procedure according
to the Veneto Regional Authority's official reimbursement tariffs, we estimated the
total and average per-patient costs by stage of disease (early or advanced) and phase
of its management.
Results
In the first year after diagnosis, the mean expected cost of a patient with RCC is
€12,991 if it is localized or locally-advanced and reaches €40,586 if it is advanced.
For early disease, the main cost is incurred by surgery, whereas medical therapy (first
and second line) and supportive care become increasingly important for metastatic
disease.
Conclusion
It is crucially important to examine the direct costs of care for RCC, and to predict
the burden on healthcare services of new oncological therapies and treatments, as
the findings could be useful for policy-makers planning the allocation of resources.
Keywords
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References
- Epidemiology of renal cell carcinoma.World J Oncol. 2020; 11: 79-87
- Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424
- Cancer incidence and mortality trends from 2003 to 2014 in Italy.Tumori. 2019; 105: 121-137
- Quality assurance and sustainability of cancer care: a European network is needed.Eur J Surg Oncol. 2018; 44: 383-385
- Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs.Cochrane Database Syst Rev. 2010; CD006632
- Facts and figures of clinical pathways in Italy: results from the PDTA Net project.Recenti Prog Med. 2019; 110: 188-194
- I PDTA come indicatori del processo di cambiamento assistenziale in sanità. CARE, Rome2017: 29-31
LINEE GUIDA TUMORI DEL RENE [Internet]. AIOM. 2018 Accessed February 26, 2021. Available from: https://www.aiom.it/linee-guida-aiom-2018-tumori-del-rene/
Portale Sanità Regione del Veneto, PDTA Rene [Internet]. 2021 Accessed February 26, 2021. Available from: https://salute.regione.veneto.it/web/rov/pdta-rene
- Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk (Alliance A031203 CABOSUN randomised trial): Progression-free survival by independent review and overall survival update.Eur J Cancer Oxf Engl. 1990; 94 (2018): 115-125
- Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial.Lancet Oncol. 2020; 21: 1563-1573
- Update on first-line combination treatment approaches in metastatic clear-cell renal cell carcinoma.Curr Treat Options Oncol. 2021; 22: 15
- The additional costs per month of progression-free survival and overall survival: an economic model comparing everolimus with cabozantinib, nivolumab, and axitinib for second-line treatment of metastatic renal cell carcinoma.J Manag Care Spec Pharm. 2018; 24: 335-343
- Health care costs among renal cancer patients using pazopanib and sunitinib.J Manag Care Spec Pharm. 2015; 21 (44a): 37-44
- Real-world treatment patterns and costs for patients with renal cell carcinoma initiating treatment with sunitinib and pazopanib.J Manag Care Spec Pharm. 2016; 22: 979-990
- Cost-effectiveness analysis of sunitinib versus interferon-alfa for first-line treatment of advanced and/or metastatic renal cell carcinoma in Singapore.Int J Technol Assess Health Care. 2019; 35: 126-133
- Cost-effectiveness of pazopanib versus sunitinib for metastatic renal cell carcinoma in the United Kingdom.PLOS ONE. 2017; 12e0175920
- Cost-effectiveness comparison of cabozantinib with everolimus, axitinib, and nivolumab in the treatment of advanced renal cell carcinoma following the failure of prior therapy in England.Clin Outcomes Res CEOR. 2018; 10: 243-250
- Costs of cancer care across the disease continuum.The Oncologist. 2018; 23: 798-805
- Determinants of medicare all-cause costs among elderly patients with renal cell carcinoma.J Manag Care Pharm. 2011; 17: 610-620
- Real-world costs and outcomes in metastatic renal cell carcinoma patients treated with targeted therapies: a cohort study from the French health insurance database.Curr Med Res Opin. 2017; 33: 1755-1762
- Kidney Cancer, Version 2.2017, NCCN clinical practice guidelines in oncology.J Natl Compr Cancer Netw JNCCN. 2017; 15: 804-834
- Decision Modelling for Health Economic Evaluation.Int J Epidemiol. 2007; 36: 476-477
- Retrospective multicenter long-term follow-up analysis of prognostic risk factors for recurrence-free, metastasis-free, cancer-specific, and overall survival after curative nephrectomy in non-metastatic renal cell carcinoma.Front Oncol [Internet]. 2019; 9 (Accessed February 26, 2021Available from:)
- Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.Ann Oncol Off J Eur Soc Med Oncol. 2016; 27: v58-v68
The Delphi Method: Techniques and Applications–(Eds.)–1975 [Internet]. Harold A. Linstone and Murray Turoff; 1975 Accessed February 26, 2021. Available from: https://web.njit.edu/∼turoff/pubs/delphibook/index.html.
Regione del Veneto. Tariffario DRG Regione del Veneto [Internet]. Available from: https://salute.regione.veneto.it/c/document_library/get_file?p_l_id=1026082&folderId=1026048&name=DLFE-32750.pdf
Regione del Veneto. Nomenclatore tariffario delle prestazioni di assistenza specialistica ambulatoriale. [Internet]. Available from: https://www.regione.veneto.it/web/sanita/assistenza-ambulatoriale
- Palliative care treatment patterns and associated costs of healthcare resource use for specific advanced cancer patients in the UK.Eur J Cancer Care (Engl). 2006; 15 (Mar): 65-73
- Current and predicted cost of metastatic renal cell carcinoma in Finland.Acta Oncol Stockh Swed. 2010; 49: 837-843
- Real-world data for direct stage-specific costs of melanoma healthcare.Br J Dermatol. 2020; 183: 171-172
Buja A, Pasello G, De Luca G. Non-small cell lung cancer: real-world cost consequence analysis. JCO Oncol Pract. In press.
- 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.PloS One. 2016; 11e0162864
- Clinical trial participants with metastatic renal cell carcinoma differ from patients treated in real-world practice.J Oncol Pract. 2015; 11: 491-497
- Pazopanib versus sunitinib in metastatic renal-cell carcinoma.N Engl J Med. 2013; 369: 722-731
Article info
Publication history
Published online: February 08, 2023
Accepted:
February 4,
2023
Received in revised form:
January 31,
2023
Received:
December 31,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
