OBJECTIVES: To assess the economic impact of early disease progression in patients with metastatic renal cell carcinoma (mRCC) treated with first-line (1L) tyrosine kinase inhibitors (TKIs) followed by second-line (2L) therapy in the US Veterans Health Administration (VHA) database.

METHODS: Newly-diagnosed adult patients with mRCC who received 1L TKI therapy followed by 2L therapy, defined as a switch to another systemic therapy from 1L, from 01OCT2013-31DEC2017, were identified in the VHA database. Eligible patients were required to have continuous health plan enrollment for ≥3 months post-2L therapy initiation unless the patient died. Using Kaplan-Meier-derived median time to 2L initiation as cut-off, patients were assigned to early (≤median) and delayed progression (>median) cohorts. All-cause per-patient-per-month (PPPM) unadjusted healthcare resource utilization and costs during the entire follow-up period post-1L therapy initiation were adjusted to 2018 US dollars ($) and compared by cohort. Total costs included the sum of medical (inpatient, outpatient) and pharmacy costs.

RESULTS: Of 271 mRCC patients, mean age was 67.9 years for the total sample. Patient characteristics were similar between the early (n=137) and delayed (n=134) progression cohorts. The median time to progression was 168 days. Patients in the early progression cohort had significantly higher mean PPPM inpatient admissions (0.2 vs 0.1), mean PPPM outpatient visits (4.0 vs 3.4), and longer mean PPPM inpatient length of stay (1.0 vs 0.4 days) (all p<0.05). The early progression cohort incurred significantly higher mean PPPM outpatient ($5,664 vs $4,078), mean PPPM medical ($8,383 vs $5,566) and mean total PPPM costs ($14,416 vs $11,053) (all p<0.05). The mean PPPM number of pharmacy visits, and inpatient and pharmacy costs were not significantly different between the two cohorts.

CONCLUSIONS: Progression on 1L TKI therapy is associated with a substantially higher economic burden. More efficacious immuno-oncology-based combination therapies that can delay disease progression have the potential to reduce such burden.