PMID- 24004437
OWN - NLM
STAT- MEDLINE
DCOM- 20140701
LR  - 20181202
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 16
IP  - 11
DP  - 2013 Nov
TI  - Economic burden of selected adverse events in patients aged >/=65 years with 
      metastatic renal cell carcinoma.
PG  - 1300-6
LID - 10.3111/13696998.2013.838570 [doi]
AB  - OBJECTIVE: To estimate the costs of adverse events (AEs) in patients aged >/=65 
      years with metastatic renal cell carcinoma (mRCC). METHODS: Retrospective study 
      using the linked Surveillance, Epidemiology and End Results (SEER) Medicare 
      database. Study subjects consisted of persons in SEER-Medicare, aged >/=65 years, 
      with evidence of newly diagnosed mRCC between January 1, 2007 and December 31, 
      2007. Adverse events of interest consisted of Grade 3 or 4 toxicities that have 
      been reported with frequency >/=5% in randomized controlled trials of sunitinib, 
      sorafenib, bevacizumab, and pazopanib (i.e., targeted therapies for mRCC), and 
      included abdominal pain, back pain, diarrhea, dyspnea, extremity pain, 
      fatigue/asthenia, hand-foot syndrome, hypertension, lymphopenia, nausea/vomiting, 
      neutropenia, proteinuria, and thrombocytopenia. Patients in SEER-Medicare with 
      these events were identified based on ICD-9-CM diagnosis codes on Medicare 
      claims. For each AE of interest, costs were tallied among evented patients over 
      30 days, beginning with the date of each patient's first mention of the AE, and 
      were compared with those of non-evented patients over a similar 30-day period 
      beginning with an identical 'shadow' index date. Total costs were compared on an 
      unadjusted basis and with adjustment for differences in baseline characteristics 
      using a generalized linear model. RESULTS: A total of 881 patients with mRCC met 
      study entry criteria; 60% of these patients had Medicare claims with mention of 
      one or more AEs of interest. Events occurring with frequency >20% included 
      abdominal pain, dyspnea, and fatigue/asthenia; 10-20% of study subjects had 
      encounters for back pain, extremity pain, and nausea/vomiting. Mean (standard 
      deviation) total cost of care over 30 days was substantially higher among 
      patients with AEs ($13,944 [$14,529]) compared with those without mention of 
      these events ($1878 [$5264]). Adjusting for differences in baseline 
      characteristics, the mean (95% confidence interval) difference in costs between 
      evented and non-evented patients was $12,410 ($9217-$16,522). Study limitations 
      include problems in event ascertainment due to inaccuracies in ICD-9-CM coding on 
      Medicare claims data, and restriction of the study population to patients with 
      metastatic involvement at initial diagnosis of RCC. CONCLUSIONS: Costs of care 
      are substantially higher in patients aged >/=65 years with mRCC who experience AEs 
      commonly associated with sunitinib, sorafenib, bevacizumab, and pazopanib. 
      Efforts to prevent and/or better manage these events potentially can reduce 
      healthcare costs.
FAU - Hagiwara, May
AU  - Hagiwara M
AD  - Policy Analysis Inc. (PAI) , Brookline, MA , USA.
FAU - Hackshaw, Michelle D
AU  - Hackshaw MD
FAU - Oster, Gerry
AU  - Oster G
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130919
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Antineoplastic Agents)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Antineoplastic Agents/*adverse effects/*economics/therapeutic use
MH  - Carcinoma, Renal Cell/*drug therapy/pathology
MH  - Female
MH  - Health Expenditures/*statistics & numerical data
MH  - Health Services/economics/statistics & numerical data
MH  - Humans
MH  - Insurance Claim Review/statistics & numerical data
MH  - Kidney Neoplasms/*drug therapy/pathology
MH  - Male
MH  - Medicare/statistics & numerical data
MH  - Neoplasm Metastasis
MH  - Randomized Controlled Trials as Topic
MH  - Retrospective Studies
MH  - SEER Program
MH  - United States
EDAT- 2013/09/06 06:00
MHDA- 2014/07/02 06:00
CRDT- 2013/09/06 06:00
PHST- 2013/09/06 06:00 [entrez]
PHST- 2013/09/06 06:00 [pubmed]
PHST- 2014/07/02 06:00 [medline]
AID - 10.3111/13696998.2013.838570 [doi]
PST - ppublish
SO  - J Med Econ. 2013 Nov;16(11):1300-6. doi: 10.3111/13696998.2013.838570. Epub 2013 
      Sep 19.