Healthcare Resource Utilization and Costs Among Patients With VHL-Associated RCC
Dr. Hasanov: Hello everyone. This is Elshad Hasanov. I’m a medical oncology fellow here at the MD Anderson Cancer Center. Today, here in the PracticeUpdate, I am with Dr. Eric Jonasch, who is a professor in our GU Medical Oncology Department. Hello, Dr. Jonasch.
Dr. Jonasch: Hey, Elshad. Great to be here.
Dr. Hasanov: So, as of this recent meeting of ASCO GU symposium, I want to ask you questions about some of the abstracts that one of them which you presented on the healthcare resource utilization and costs among patients with VHL-associated renal cell carcinoma.
Dr. Jonasch: Great.
Dr. Hasanov: So, what was the scope of this study that you were looking for, and how it was designed?
Dr. Jonasch: Yeah, so Elshad, one of the key questions as new agents are becoming available for the treatment of von Hippel-Lindau disease like belzutifan is what’s the value proposition for actually using oral agents in that population. And part of our way to understand that is to find out what does it cost to treat a VHL patient. And so the way this was done, this was actually done in conjunction with Merck, was to take a clinical claims database, the Optum clinic form medics claims database, to identify individuals who have VHL disease, and then to see what their healthcare utilization was. So, this is actually a really challenging and interesting exercise is to actually create algorithms to find individuals in these types of databases. First of all, it would have to be individuals with renal cell carcinoma but then people with renal cell carcinoma plus at least a few other VHL-related disease manifestations.
And because there is, as of now, no ICD code for VHL disease per se, we had to go through multiple iterations of that algorithm to be able to come up with something that looked plausible and reasonable, taking this fairly large database, but then scaling up the numbers at a national level to come up with this type of set of patients that we could really look at. So, that’s basically just a background on it, and I’m happy to answer any other questions.
Dr. Hasanov: Sure. Yeah, this is very interesting, and I’m glad to hear about the availability of this research that can be applicable to many other questions. So, what were the key findings of this study?
Dr. Jonasch: Yeah, with this clinical claims database, we ended up actually identifying around 160 people that we really felt were people with VHL disease and renal cell carcinoma. Median age was around 51 years, which is a little old, but I think still a reasonable sort of age range for these individuals. And we saw that these individuals incurred hospitalizations at a certain rate, outpatient visits, etcetera, that really resulted in a monthly all-cause healthcare cost of about $4,000 per month for these individuals that’s including about half of that was inpatient and the rest of it was other.
So, certainly not an insignificant cost for the VHL-related renal cell carcinoma. You also noticed that there was significant cost for the central nervous system hemangioblastomas at the order of about $2,000 per month and about $3,000 a month for the neuroendocrine tumors. The other thing is that just the cost of, for example, a nephrectomy close to $30,000, a hemangioblastoma surgery about $70,000, and then the neuroendocrine tumor surgery is about $81,000. So, not as much per month as what one would pay for a typical TKI but not insubstantial as well.
Dr. Hasanov: I see. Now, based on these findings, what do you think that the decision making should be together with the patients and the physicians in terms of the implication of the belzutifan versus waiting for another surgery? So, how do you think that this new knowledge will help our practice?
Dr. Jonasch: So, I think the bottom line is that TKIs, or small molecule inhibitors, are still always going to be a somewhat expensive proposition. But what we are seeing from this study is that not treating is also an expensive proposition, and then factoring in the psychological cost of having to undergo surgery, this does not take into consideration things like loss of productivity and loss of revenue when patients are either off work for surgeries or then develop disability from the surgeries themselves. I think we can have a value-based conversation about the use of chronic belzutifan, for example, in VHL patients.
Dr. Hasanov: Thank you very much. This was very informative and critical study making these decisions with the availability of resources both in United States and other countries that I think this cost-based understanding will also help for both physicians and clinicians to decide which way that will be most feasible for an individual patient to move forward with. Thank you very much.
Dr. Jonasch: Thank you, Elshad.
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