OBJECTIVES : Economic and clinical impacts of post-nephrectomy recurrence of RCC have not been reported in the literature. This study aims to assess the impact of RCC recurrence on healthcare resource utilization (HRU), healthcare costs, and overall survival (OS) in the US.

METHODS : The SEER-Medicare database (2007–2016) was used to identify patients with newly diagnosed, intermediate-high risk or high-risk RCC after nephrectomy. Index date for patients with recurrence was 30 days prior to recurrence (a diagnosis of metastatic disease, additional nephrectomy, or initiating a systemic treatment for advanced RCC). For patients without recurrence, the index date was randomly assigned to match the distribution of time elapsed between initial nephrectomy and index date of the recurrence cohort. Patients were followed over the entire period that a patient had continuous enrollment after index date. Baseline characteristics, HRU, healthcare costs (in 2019 USD), and OS were compared between the two cohorts.

RESULTS : 269 patients with recurrence and 374 patients without recurrence met the inclusion criteria and had comparable baseline characteristics. During the study period, the recurrence cohort had more all-cause inpatient admissions (0.16 vs 0.04 admissions/person-month [PM]; adjusted incidence rate ratio [aIRR]=3.88), outpatient visits (3.06 vs 1.77 visits/PM; aIRR=1.68), emergency department visits (0.10 vs 0.05 visits/PM; aIRR=2.11), and days hospitalized (1.40 vs 0.35 days/PM; aIRR=6.73) (all P<0.001). Adjusted Per-patient-per-month (PPPM) costs were significantly higher in the recurrence cohort: all-cause total medical costs, inpatient admissions, outpatient visits, SNF stays, and pharmacy were $4,924, $3,365, $983, $371, and $1,387 higher for patients with recurrence, respectively (all P<0.001). Patients with recurrence were associated with significantly shorter OS (adjusted hazard ratio=6.00; P<0.001).

CONCLUSIONS : Post-nephrectomy recurrence of RCC is associated with significantly increased HRU, healthcare costs, and mortality, which highlights the substantial unmet need for adjuvant therapy to understand and reduce recurrence risk among this patient population.