{"doi":"10.1093/jncics/pkae067","title":"Cost trends of metastatic renal cell carcinoma therapy: the impact of oral anticancer agents and immunotherapy","abstract":"BACKGROUND: Immunotherapy (IO) and oral anticancer agents (OAA) have improved outcomes for metastatic renal cell carcinoma (mRCC), but there is a need to understand real-world costs from the perspective of payers and patients. METHODS: We used retrospective fee-for-service Medicare 100% claims data to study patients diagnosed with mRCC in 2015-2019. We identified initial treatment type and costs (the year after diagnosis) and analyzed differences in monthly and 12-month costs over time and between OAA, IO, and combination groups and the association between Out-Of-Pocket (OOP) costs and adherence. RESULTS: We identified 15 407 patients with mRCC (61% male; 85% non-Hispanic White). A total of 6196 received OAA, IO, or combination OAA/IO as initial treatment. OAA use decreased (from 31% to 11%) with a simultaneous rise in patients receiving IO (3% to 26%) or combination IO/OAA therapy (1% to 11%). Medicare payments for all patients with mRCC increased by 41%, from $60 320 (95% confidence interval = 58 260 to 62 380) in 2015 to $85 130 (95% confidence interval = 82 630 to 87 630) in 2019. Payments increased in patients who received OAA, IO, or combination OAA/IO but were stable in those with other/no treatment. Initial higher OOP responsibility ($200-$1000) was associated with 13% decrease in percent days covered in patients receiving OAA in the first 90 days of treatment, compared with those whose OOP responsibility was less than $200. CONCLUSION: From 2015 to 2019, costs for Medicare patients with mRCC rose substantially due to more patients receiving IO or IO/OAA combined therapy and increases in costs among those receiving those therapies. Increased OOP costs was associated with decreased adherence.","journal":"JNCI Cancer Spectrum","year":2024,"id":481034,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7389,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":766282,"name":"Jessica B. Long","orcid":null,"position":1,"is_corresponding":false},{"id":1173463,"name":"Sarah J. Westvold","orcid":"0009-0004-2060-2137","position":2,"is_corresponding":false},{"id":1321154,"name":"Khushi Agnish","orcid":null,"position":3,"is_corresponding":false},{"id":1107611,"name":"Hannah D. McManus","orcid":"0000-0003-1455-2976","position":4,"is_corresponding":false},{"id":531890,"name":"Michael Leapman","orcid":"0000-0002-0727-7614","position":5,"is_corresponding":false},{"id":854419,"name":"Michael E. Hurwitz","orcid":"0000-0002-1326-7308","position":6,"is_corresponding":false},{"id":322355,"name":"Lisa P. Spees","orcid":"0000-0002-5680-9330","position":7,"is_corresponding":false},{"id":387633,"name":"Stephanie B. Wheeler","orcid":"0000-0002-3399-9047","position":8,"is_corresponding":false},{"id":237714,"name":"Cary P. Gross","orcid":"0000-0002-4974-935X","position":9,"is_corresponding":false},{"id":547119,"name":"Michaela A. Dinan","orcid":"0000-0003-4849-4743","position":10,"is_corresponding":false},{"id":1320810,"name":"Rebecca Forman","orcid":"0000-0002-3012-4712","position":0,"is_corresponding":true}],"reference_count":47,"raw_metadata":null,"created_at":"2026-07-19T02:07:06.225103Z","pmid":"39133171","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}