Real-World Utilization of Oral Anticancer Agents and Related Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States.
Real-World Utilization of Oral Anticancer Agents and Related Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States.
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DOI：
10.3233/kca-210119
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Dinan MA
中科院分区：
文献类型：
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作者：
Wilson LE;Spees L;Pritchard J;Greiner MA;Scales CD Jr;Baggett CD;Kaye D;George DJ;Zhang T;Wheeler SB;Dinan MA
在引入靶向口服抗癌药物（OAAs）后，转移性RCC （mRCC）的种族和社会经济差异仍然存在。患者特征与OAA获取和费用之间的关系可能是mRCC结果持续差异的基础，但尚未在全国代表性患者人群中进行研究。回顾性SEER-Medicare分析2007-2015年诊断为mRCC的65岁以上医疗保险D部分处方药覆盖患者。在mRCC诊断后的12个月内，分析患者特征、OAA收据和相关费用之间的关系，并调整为2015年美元。2792例患者符合纳入标准，其中32.4%的患者获得了OAA。大多数患者接受舒尼替尼（57%）或帕唑帕尼（28%）作为首次口服治疗。领取OAA的情况没有因种族/民族或社会经济指标而异。高龄患者（60 ~ 80岁）、未婚患者和居住在美国南部的患者接受oaa的可能性较小。经通货膨胀调整后，患者第一次OAA处方的平均30天医疗保险费用几乎翻了一番，从2007年的3864美元增加到2015年的7482美元，而患者自付费用从2409美元下降到1477美元。种族、民族和社会经济地位与mRCC患者OAA摄入量减少无关；然而，居住在美国南部，婚姻状况也是如此。令人惊讶的是，从2007年到2015年，医疗保险的初始OAA处方费用几乎翻了一番，而患者的自付费用却大幅下降。在个性化医疗时代，OAA成本的变化可能会产生重大的经济影响。
Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (> 80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.