Treatment Patterns and Costs Among Patients With Metastatic Renal Cell Carcinoma in the United States: A Real-World Study Using Integrated Claims and Clinical Data

PURPOSE The treatment landscape for metastatic renal cell carcinoma (mRCC) has evolved in recent years with the use of tyrosine kinase inhibitors (TKIs) and immuno-oncology (IO) therapies. This study examined patient characteristics, treatment patterns, health care resource utilization (HCRU), costs, and survival for individuals with mRCC who received either IO + IO or IO + TKI combinations as first-line (1L) regimens. METHODS This retrospective cohort study used integrated claims and clinical data from a commercial health plan to study adults with mRCC who began 1L treatment between April 1, 2018, and January 31, 2023. Patient characteristics, 1L and second-line (2L) regimens, and HCRU were described. Costs were summarized per patient per month over time. Survival time was analyzed overall and partitioned into time on 1L, treatment-free survival, and survival after 2L. RESULTS Patients receiving 1L IO + IO (n = 471) or IO + TKI (n = 353) regimens generally had similar baseline characteristics although among patients with risk data, 33% of IO-IO patients versus 23% of IO-TKI patients had poor risk scores. Treatment costs were higher for IO + IO in the first 3 months but lower in subsequent time intervals compared with IO + TKI. Total mean costs per patient were $720K in US dollars (USD) for IO + IO and $834K USD for IO + TKI over the course of 3 years. Medication costs represented 80% of total costs. IO + IO patients stayed on 1L therapy for a shorter duration, but cumulative survival time at 24 months was the same (63%) for both groups. CONCLUSION Patients receiving 1L IO + IO and IO + TKI regimens had similar baseline characteristics and comparable survival at 30 months. Although IO + IO was associated with higher treatment costs in the first 3 months, the subsequent monthly costs were lower compared with IO + TKI.