Comparing two tyrosine kinase inhibitors for treatment of advanced renal cell carcinoma in Medicare and commercially insured patients
Comparing two tyrosine kinase inhibitors for treatment of advanced renal cell carcinoma in Medicare and commercially insured patients
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DOI：
10.1185/03007995.2015.1081881
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发表时间：
2015-01-01
影响因子：
2.3
通讯作者：
Worley, Karen
中科院分区：
文献类型：
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作者：
Racsa, Patrick N.;Whisman, Tyler R.;Worley, Karen
目的：本研究的目的是在现实环境中比较舒尼替尼和帕佐帕尼治疗晚期肾细胞癌(RCC)的治疗特点、生存率和成本。方法：使用索赔数据，这项观察性、回顾性队列研究选择了在2009年11月1日至2012年12月31日期间，年龄在19岁至89岁之间、拥有商业或医疗保险、晚期RCC、至少一次药房索赔的患者。对治疗特征(治疗中断、坚持治疗、持续时间和停止治疗)、生存期和费用进行测量，最长可达12个月。统计模型根据年龄、性别、地理区域、种族和RxRisk-V评分进行了调整。结果：在基线时，pazopanib患者的健康状况指标(RxRisk-V评分、药房索赔数量和指数前的总医疗费用)明显低于Sunitinib患者。在治疗特征或存活率方面没有差异。服用舒尼替尼的指数药物费用(平均差异5580美元，p=0.03，adj p=0.05)和总医疗费用(平均差异12,192美元，p=0.09，adj p=0.07)呈上升趋势。未依从性服用舒尼替尼的患者花费的总费用显著高于未依从性服用帕佐帕尼的患者(平均差异17,680美元，p=0.04，adj p=0.01)。结论：死亡率数据和治疗效果的替代变量表明两种药物具有相似的临床价值。舒尼替尼治疗倾向于更高的指数药物和总医疗成本，尽管指数前总成本更高，使用pazopanib的基线健康状况指标更差。不坚持使用舒尼替尼与显著更高的总医疗费用相关，这可能表明两种药物之间的耐受性差异，需要进一步调查。
Objective:The objective of this study was to compare treatment characteristics, survival and costs for sunitinib and pazopanib for advanced renal cell carcinoma (RCC) in a real-world setting.Methods:Using claims data, this observational, retrospective cohort study selected individuals aged 19 to 89 years, with commercial or Medicare insurance, advanced RCC, and at least one pharmacy claim for sunitinib or pazopanib between 1 November 2009 and 31 December 2012. Treatment characteristics (treatment interruption, adherence, duration and discontinuation), survival, and costs were measured up to 12 months. Statistical models were adjusted for age, gender, geographic region, race, and RxRisk-V score.Results:At baseline, pazopanib patients exhibited significantly worse health status indicators (RxRisk-V score, number of pharmacy claims, and pre-index total healthcare costs) than sunitinib patients. There were no differences in treatment characteristics or survival. Index medication costs (mean difference $5580, p = 0.03, adj p = 0.05) and total healthcare costs (mean difference $12,192, p = 0.09, adj p = 0.07) trended higher with sunitinib. Patients non-adherent with sunitinib incurred significantly higher total costs compared to patients non-adherent with pazopanib (mean difference $17,680, p = 0.04, adj p = 0.01).Conclusions:Mortality data and proxy variables for treatment effectiveness indicate comparable clinical value for both medications. Sunitinib treatment trended towards higher index medication and total healthcare costs despite higher pre-index total costs and worse health status indicators at baseline with pazopanib. Non-adherence with sunitinib was associated with significantly higher total healthcare costs, which may indicate differences in tolerability between the two agents and requires further investigation.