肾癌治疗的范式转变导致了更高的医疗保健支出。本文利用卫生指标与评估研究院为疾病支出项目开发的公共数据库，估算了1996-2016年美国肾癌总医疗保健支出、人均医疗保健支出和影响健康支出变化的主要因素。肾癌患病率来自全球负担疾病研究。通过联合点回归进行肾癌医疗保健支出变化评估，并以年度百分比变化（APC）表示。2016年，肾癌总医疗保健支出为34.2亿美元（95％CI：29.1亿美元至38.9亿美元），而1996年为11.8亿美元（95％CI：10.7亿美元至13.1亿美元）。人均支出在2005年和2008年有两个拐点，接近靶向治疗批准年份，分别对应于1996-2005年的APCs为+2.9％（95％CI，+2.3％至+3.6％；P< 0.001），2005-2008年的APCs为+9.2％（95％CI，+3.4％至+15.2％；P=0.004），2008-2016年的APCs为+3.1％（95％CI，+2.2％至+3.9％；P<0.001）。住院治疗是医疗支出的最大贡献者，在2016年占了15.6亿美元（95％CI：11.9亿美元至19.5亿美元）。医疗服务价格和强度是增加医疗保健支出的主要驱动因素，而服务利用是减少医疗保健支出的主要驱动因素。在美国，肾癌医疗保健支出的患病率调整继续上升，主要是由于住院治疗引起的，并随着时间的推移受到医疗服务价格和强度的推动。 © 2023美国癌症学会。

Paradigm shifts in kidney cancer management have led to higher health care spending. Here, total and per capita health care spending and primary drivers of change in health expenditures for kidney cancer in the United States between 1996 and 2016 are estimated.Public databases developed by the Institute for Health Metrics and Evaluation for the Disease Expenditure Project were used. The prevalence of kidney cancer was estimated from the Global Burden of Disease Study. Changes in health care spending on kidney cancer were assessed by joinpoint regression and expressed as annual percent changes (APCs).In 2016, total health care spending on kidney cancer was $3.42 billion (95% CI, $2.91 billion to $3.89 billion) compared with $1.18 billion (95% CI, $1.07 billion to $1.31 billion) in 1996. Per capita spending had two inflection points in 2005 and 2008, close to the approval years of targeted therapies, which corresponded to APCs of +2.9% (95% CI, +2.3% to +3.6%; p < .001) per year, 1996-2005; +9.2% (95% CI, +3.4% to +15.2%; p = .004) per year, 2005-2008; and +3.1% (95% CI, +2.2% to +3.9%; p < .001) per year, 2008-2016. Inpatient care was the largest contributor to health expenditures, which accounted for $1.56 billion (95% CI, $1.19 billion to $1.95 billion) in 2016. Price and intensity of care was the primary driver of increased health expenditures, whereas service utilization was the primary driver of reduced health expenditures.Prevalence-adjusted health care spending on kidney cancer continues to rise in the United States, which is primarily attributable to inpatient care and driven by the price and intensity of care over time.© 2023 American Cancer Society.