OBJECTIVES: Kidney cancer is placed third in urologic cancers in Canada, right behind prostate and bladder cancer. Many new therapeutic options are being developed in the metastatic phase mainly, but these innovations are being presented with high costs. The objective of the current study is thus to establish clinical and economic outcomes of the current practice in RCC treatment in Canada post-nephrectomy.

METHODS: A Markov model with microsimulation was developed to estimate the cost of follow-up and treating patients from post-nephrectomy up to diagnosis of metastatic RCC and death from any cause. The model included 5 health states: Active Surveillance, Local recurrence, mRCC, death from RCC or death from other causes. Probabilities were adjusted by taking in consideration patient characteristics and most estimate were extracted from real-world evidence studies assessing the survival of RCC and mRCC patients. Costs were extracted from available literature. Deterministic sensitivity analysis was conducted to account for uncertainty on different parameters by varying parameters by 25%.

RESULTS: Mean survival (± SD) was evaluated to be 15.56 ± 5.69 life years (LYs) for T1 tumours, 13.22 ± 5.68 LY for T2, 12.22 ± 5.52 LY for T3 and 14.85 ± 5.71 LY for the weighted average of the 3 stages. The weighted mean and median total cost of the disease amounts to 107 811.22$ and 48 992.33$ respectively over a 20-year time horizon. In the weighted average scenario, the mRCC state costs represented the main burden, at around 40.3% of total cost. The local recurrence, active surveillance, death and kidney cancer related death states respectively represented 27.2%, 23.8%, 8.6% and 0.1%.

CONCLUSIONS: The economic burden of mRCC is increasing with the severity of the disease. The results given in the present work are preliminary and constitute a groundwork for future studies that need to be done integrating newer treatment option.