Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy: a real-world observational study

Abstract

Aims: To assess healthcare costs during treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and following disease progression in patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective analysis of medical records of US community oncology practices was conducted. Eligible patients had advanced NSCLC (stage IIIB/IV) diagnosed between January 1, 2008 and January 1, 2015, initiated treatment with erlotinib or afatinib (first-line or second-line), and had disease progression. Monthly Medicare-paid costs were evaluated during the TKI therapy period and following progression. Results: The study included 364 patients. The total mean monthly cost during TKI therapy was $20,106 (95% confidence interval [CI] ¼ $16,836-$23,376), of which 47.0% and 42.4% represented hospitalization costs and anti-cancer therapy costs, respectively. Following progression on TKI therapy (data available for 316 patients), total mean monthly cost was $19,274 (95% CI ¼ $15,329-$23,218), and was higher in the 76.3% of patients who received anti-cancer therapy following progression than in the 23.7% of those who did not ($20,490 vs $15,364; p < .001). Among patients who received it, anticancer therapy ($11,198; 95% CI ¼ $7,102-$15,295) represented 54.7% of total mean monthly cost. Among patients who did not receive anti-cancer therapy, hospitalization ($13,829; 95% CI ¼ $4,922-$22,736) represented 90.0% of total mean monthly cost. Impaired performance status and brain metastases were significant predictors of increased cost during TKI therapy. Limitations: The study design may limit the generalizability of findings. Conclusions: Healthcare costs during TKI treatment and following progression appeared to be similar and were largely attributed to hospitalization and anti-cancer therapy. Notably, almost one-quarter of patients did not receive anti-cancer therapy following progression, potentially indicating an unmet need; hospitalization was the largest cost contributor for these patients. Additional effective targeted therapies are needed that could prolong progression-free survival, leading to fewer hospitalizations for EGFR mutation-positive patients.ARTICLE HISTORY

Cost burden associated with advanced non-small cell lung cancer in Europe and influence of disease stage

“…More recently, Migliorino et al found that costs including those related to physician visits, hospitalizations, medication, laboratory tests, and palliative care increased as patients experienced disease progression and received sequential lines of therapy [15]. A similar pattern of costs increasing with disease progression was also reported for patients with stage IIIB or stage IV disease receiving treatment with tyrosine kinase inhibitors, with direct medical and associated healthcare costs increasing with disease progression [20]. The current evaluation adds to these observations and has shown that direct out-of-pocket expenses incurred by the patient are influenced by the disease stage.…”

<p>Costs and Cost Drivers Associated with Non-Small-Cell Lung Cancer Patients Who Received Two or More Lines of Therapy in Europe</p>

“…This trend was also found in a chart review study in the United States of aNSCLC patients with at least one line of erlotinib or afatinib. 11 A chart review study of hospital-based costs from Brazil, however, suggested an effect of ECOG PS = 2 leading to lower total costs, which were potentially due to delayed rather than avoided costs. 12 ISC-IASLC disease stage was not a significant predictor in our study, potentially due to the study being restricted to patients with stage IIIB/IVaNSCLC, but was found a significant predictor in other chart reviews.…”

Effects of different metastasis patterns, surgery and other factors on the prognosis of patients with stage�IV non‑small cell lung cancer: A Surveillance, Epidemiology, and End Results (SEER) linked database analysis

“…The emergence of drug resistance in tumor cells may lead to treatment failure in a patient population that is suitable for targeted therapy (7). In addition, both targeted therapy and immunotherapy may be economically unfeasible for patients with lung cancer (8,9). Accordingly, cost-effective treatment alternatives for patients with lung cancer are required.…”