Cost implications of IV versus oral anti-angiogenesis therapies in patients with advanced renal cell carcinoma: retrospective claims database analysis.

OBJECTIVE: Angiogenesis inhibitors (AI) are promising novel treatments for patients with renal cell carcinoma (RCC). However, IV therapy may impose infection risk from IV catheters, and will include increased costs due to administration and transportation costs. This study evaluated the incremental costs associated with IV administration of selected AI therapies (bevacizumab off-label) compared to oral therapies (sunitinib or sorafenib) for the treatment of RCC. METHODS: Patients with > or =2 RCC claims (ICD-9: 189.0, 198.0) were identified from a US commercial health insurance claims database from 1/2004 to 12/2007. Patients receiving bevacizumab (n = 109) were matched 1:1 to patients receiving sorafenib or sunitinib, and observed from their first AI therapy claim until the last treatment date. AI, inpatient, outpatient and pharmacy costs were calculated on a per-patient per-month (PPPM) basis over the treatment period. Costs were compared between the IV AI group and each separate oral AI group using multivariate Tobit regressions for each category separately, adjusting for demographic and baseline clinical characteristics. This study assessed costs of treatment and did not evaluate the cost-effectiveness of AIs. RESULTS: Mean total medical costs were $13,351, $6998, and $8213 PPPM for bevacizumab, sorafenib, and sunitinib, respectively (p <0.05 for equality). Adjusted incremental total cost for the bevacizumab group was $4951 PPPM compared to sorafenib and $4610 PPPM compared to sunitinib (both p < 0.05). Bevacizumab patients incurred incremental PPPM outpatient services cost compared to sorafenib and sunitinib of $2772 and $2548, respectively (both p < 0.05). CONCLUSIONS: Assuming median progression-free survival of 8.5 months as shown for bevacizumab (Bukowski, et al., J Clin Oncol 2007), the incremental costs would be estimated at $39 188-42 080 per patient compared to those treated with sunitinib or sorafenib. Assuming similar efficacies, oral AI therapies may result in cost savings to patients and healthcare payers over IV therapies.

Mortality effects of a copper smelter strike and reduced ambient sulfate particulate matter air pollution.

BACKGROUND: Numerous studies have reported associations between fine particulate and sulfur oxide air pollution and human mortality. Yet there continues to be concern that public policy efforts to improve air quality may not produce actual improvement in human health. OBJECTIVES: This study retrospectively explored a natural experiment associated with a copper smelter strike from 15 July 1967 through the beginning of April 1968. METHODS: In the 1960s, copper smelters accounted for approximately 90% of all sulfate emissions in the four Southwest states of New Mexico, Arizona, Utah, and Nevada. Over the 8.5-month strike period, a regional improvement in visibility accompanied an approximately 60% decrease in concentrations of suspended sulfate particles. We collected monthly mortality counts for 1960-1975 and analyzed them using Poisson regression models. RESULTS: The strike-related estimated percent decrease in mortality was 2.5% (95% confidence interval, 1.1-4.0%), based on a Poisson regression model that controlled for time trends, mortality counts in bordering states, and nationwide mortality counts for influenza/pneumonia, cardiovascular, and other respiratory deaths. CONCLUSIONS: These results contribute to the growing body of evidence that ambient sulfate particulate matter and related air pollutants are adversely associated with human health and that the reduction in this pollution can result in reduced mortality.