Comparison of demographics, treatment patterns, health care utilization, and costs among elderly patients with extensive-stage small cell and metastatic non-small cell lung cancers

Abstract

BackgroundLimited data exist regarding real-world treatment patterns, resource utilization, and costs of extensive-stage small cell lung cancer (esSCLC) among elderly patients in the United States. While abundant data are available on treatment patterns in metastatic non-small cell lung cancer (mNSCLC), to our knowledge no data exist comparing costs and resource use between patients with esSCLC or mNSCLC.MethodsWe retrospectively analyzed administrative claims data (2000–2008) of patients aged ≥65 years from the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database. Patients were selected on the basis of having newly diagnosed esSCLC (n=5,855) or mNSCLC (n=24,090) during 1/1/2000-12/31/2005, and were required to have received cancer-directed therapy. Survival and other measures were compared between esSCLC and mNSCLC patients using Kaplan-Meier log-rank and univariate chi-square and t-tests. Study measures were followed from first diagnosis date of either esSCLC or mNSCLC until the earlier of death or end of the database.ResultsSurvival between the cohorts did not differ significantly: mean of 10.4 months for esSCLC patients versus 11.1 months for mNSCLC; median survival was 7.4 months versus 5.9 months. A higher percentage of mNSCLC patients (vs. esSCLC) received radiation therapy (75.6% vs. 65.4%; P < 0.001) and surgery (13.6% vs. 7.8%; P < 0.001) during the metastatic disease period. Conversely, a higher percentage of esSCLC patients than mNSCLC patients received chemotherapy (85.5% vs. 60.3%; P < 0.001), red blood-cell transfusion (20.7% vs. 10.9%; P < 0.001), platelet transfusion (5.6% vs. 1.8%; P < 0.001), and growth-factor support (59.0% vs. 39.5%; P < 0.001). esSCLC patients incurred higher lifetime disease-related costs ($44,167 vs. $37,932; P < 0.001) and all-cause costs ($70,549 vs. $67,176; P < 0.001) than mNSCLC patients.ConclusionsLifetime total and disease-related costs per patient were high. Increased use of chemotherapy, supportive care therapies (including growth factors), and disease-related hospitalizations were observed in esSCLC patients as compared with mNSCLC patients. Disease-related and all-cause costs for esSCLC also exceeded those of mNSCLC, except for hospice and skilled nursing services. Survival and per-patient costs for both groups underscore the unmet medical need for more effective therapies in patients with esSCLC or mNSCLC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0555-8) contains supplementary material, which is available to authorized users.

Real-world treatment patterns and costs in a US Medicare population with metastatic squamous non-small cell lung cancer

“…This is the first study, to our knowledge, providing estimates of the direct economic burden of metastatic squamous NSCLC among elderly Medicare beneficiaries and how costs of care are distributed across various types of medical resources and predefined periods of disease course. Total all-cause costs estimated in our study were high and similar to those reported for NSCLC (all histology subtypes) in another recent study [46]. Consistent with the findings of Karve and colleagues [46], hospitalization was the largest driver of total costs, followed by outpatient visits.…”

“…Total all-cause costs estimated in our study were high and similar to those reported for NSCLC (all histology subtypes) in another recent study [46]. Consistent with the findings of Karve and colleagues [46], hospitalization was the largest driver of total costs, followed by outpatient visits.…”

Adherence to granulocyte-colony stimulating factor (G-CSF) guidelines to reduce the incidence of febrile neutropenia after chemotherapy—a representative sample survey in Germany

“…Our data and other studies do not provide plausible explanations for this finding which, therefore, should be explored further in subsequent studies [11,13,19,20,23].…”

“…A large US study in patients older than 65 years with metastatic NSCLC revealed a 17.8 % use of myeloid growth factors and of 42.4 % with extensive SCLC [20], which is below the anticipated percentage. The supportive care with growth factors in lung cancer patients is insufficient as well in different health care systems as in various European countries [23] or in the USA [11,20].…”

“…The supportive care with growth factors in lung cancer patients is insufficient as well in different health care systems as in various European countries [23] or in the USA [11,20]. The reasons for this pronounced problem in lung cancer remain to be elucidated.…”