Estimated Direct Costs of Renal Cancer by Stage of Disease at Diagnosis and Phase of Its Management: A Whole-Disease Model

This study estimated the direct costs of managing renal cell carcinoma, the seventh most common neoplasm in high-income countries, through the development of a whole disease model based on clinical pathways, pondering the probabilities of all diagnostic-therapeutic procedures and linking the reimbursement tariff to each procedure. The results of this work could provide useful insights for policy-makers planning healthcare resources allocation. Background: Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which includes costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs . advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines. Materials and Methods: Considering the clinical pathway for RCC adopted in the Veneto region (nor th-east Italy) and the latest guidelines, we developed a very detailed "whole-disease" model that covers the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of RCC. Based on the cost of each procedure according to the Veneto Regional Authority's official reimbursement tariffs, we estimated the total and average per-patient costs by stage of disease (early or advanced) and phase of its management. Results: In the first year after diagnosis, the mean expected cost of a patient with RCC is euro12,991 if it is localized or locally-advanced and reaches euro40,586 if it is advanced. For early disease, the main cost is incurred by surgery, whereas medical therapy (first and second line) and supportive care become increasingly important for metastatic disease. Conclusion: It is crucially important to examine the direct costs of care for RCC, and to predict the burden on healthcare services of new oncological therapies and treatments, as the findings could be useful for policy-makers planning the allocation of resources.