Costs associated with angiogenesis inhibitor therapies for metastatic renal cell carcinoma in clinical practice: Results from a medical chart review study

Objective: To estimate costs for treatment of mRCC patients receiving angiogenesis inhibitors (AI) using resource utilization data from medical charts. Materials and methods: A retrospective chart review was performed in two U.S. tertiary oncology centers. Non-trial mRCC patients treated from 04/2003 to 06/2008, ≥18 years old, and with ≥1 prescription for sunitinib (SU; n ≥ 57), sorafenib (SOR; n ≥ 62), or ≥1 intravenous (i.v.) administration bevacizumab (BEV; n ≥ 25) as first AI were included. Per-patient-per-month (PPPM) costs ($2008) were estimated for drug, i.v. administration, office visits, procedures, and AE treatments. AI drug costs were estimated by applying Average Wholesale Price to treatment course. Office visit and procedure costs were based on private insurance reimbursement. Hospitalization costs were based on HCUP National Inpatient Sample charges for AEs and were converted to costs. ER visit cost was based on national average from Medical Expenditure Panel Survey. Results: Median treatment duration (mo) was 10.5 (SU), 8.1 (SOR), 7.9 (BEV). Average daily oral dosage was 32 mg (SU), 690 mg (SOR); average dose per i.v. administration was 871 mg (BEV). Total PPPM costs were $7,945 (SU), $6,990 (SOR), $15,189 (BEV). AI drugs accounted for the majority of PPPM costs ($5,639 [SU], $5,214 [SOR], $13,664 [BEV]), followed by procedures ($1,420 [SU], $1,004 [SOR], $749 [BEV]), and AE treatments ($729 [SU], $636 [SOR], $291 [BEV]). Conclusions: BEV patients incurred about twice the cost of SU patients and more than twice the cost of SOR patients, mainly due to higher drug and i.v. administration costs. Patients who received SU incurred the highest cost for AE management.