Treatment Patterns and Healthcare Costs among Patients with Advanced Non-Small-Cell Lung Cancer

Abstract

Aim: To identify contemporary first-and second-line treatment patterns for advanced non-small-cell lung cancer (aNSCLC) and associated costs. Methods: This study identified aNSCLC patients through an oncology registry linked to a large US commercial claims database. Patients with aNSCLC (stage IIIb or IV) and continuous enrollment in the health plan from diagnosis until death were included. First and second lines of therapy and their associated costs were determined. Results: The most common first-line regimens (n = 335) were platinum-taxane doublets alone (29%) or in combination with bevacizumab (14%) or pemetrexed (6%). Most second-line regimens (n = 74) contained pemetrexed, Background ū Treatment options for patients with advanced non-small-cell lung cancer (aNSCLC) have been expanding with the development of predictive biomarkers and biologically targeted treatments.ū This study coupled US healthcare claims data with cell type and disease stage information from an oncology registry to assess contemporary systemic treatment patterns for patients with aNSCLC in clinical practice. Treatment patterns & healthcare costsū Platinum-taxane doublet regimens were the most common first-line treatment (29%), followed by bevacizumab plus platinum-taxane doublets (14%). Two or more newer agents (bevacizumab, erlotinib and/or pemetrexed) were included in 16% of first-line regimens. ū The majority of second-line regimens (76%) included bevacizumab, erlotinib and pemetrexed. ū Total healthcare costs varied widely depending on regimen, ranging from US$19,812 to US$167,847 for first-line regimens and US$35,737 to US$135,364 for second-line regimens. ū Systemic therapy represented 20-55% of total first-line costs and 22-68% of total second-line costs. Conclusion ū These results demonstrate the emerging use of targeted agents and the potential cost implications of systemic treatments for aNSCLC. Summary PointsTreatment patterns and healthcare costs among patients with advanced non-small-cell lung cancer

Real-world first-line treatment and overall survival in non-small cell lung cancer without known EGFR mutations or ALK rearrangements in US community oncology setting

“…Only several published studies describe real-world practice patterns of first-line therapy for NSCLC in the US [ 10 , 11 , 20 – 22 ]. The two most recent studies—Zornosa et al [ 10 ] (2006–2009 data) and Henk et al [ 10 ] (2006–2010 data)—were from periods before approval of maintenance therapies [ 23 , 24 ] and identification of the importance of histology in chemotherapy selection [ 25 ].…”

“…First, the proportion of metastatic NSCLC patients receiving first line therapy has risen over time from 52% in 2000 [ 22 ] and 59% in 2007, [ 22 ] to 79%-80% in 2009 [ 10 ] and here. Second, consistent with guidelines, a carboplatin doublet is the most common induction regimen [ 4 , 5 , 10 , 20 , 21 ], followed by carboplatin doublet and bevacizumab [ 10 , 11 , 21 ].…”

“…However, there are very limited data to describe treatment patterns and survival for metastatic NSCLC, which aimed to identify and exclude patients with actionable mutations using real world data sources. The most recent publications examined data through early 2010 [ 10 , 11 ], before the publication of continuation and switch maintenance trials [ 12 – 14 ]. The aim of this study was to describe overall survival (OS) with current first-line treatment for patients presenting with stage IV NSCLC without known EGFR or ALK tumor aberrations across a broad range of community oncology practices in the United States (US).…”

Validation of a Plasma-Based Comprehensive Cancer Genotyping Assay Utilizing Orthogonal Tissue- and Plasma-Based Methodologies

“…Modern systemic cancer therapy is evolving away from cytotoxic polychemotherapy to embrace novel therapeutics targeting molecular characteristics specific to individual patients' tumors that deliver superior clinical outcomes at reduced toxicity and overall cost (1,2). Indeed, precision oncology is the preferred standard of care in National Comprehensive Cancer Network (NCCN) treatment guidelines (3) for advanced non-small cell lung cancer (NSCLC), colorectal cancer, melanoma, breast cancer, gastric and gastroesophageal adenocarcinoma, and gastrointestinal stromal tumors and is rapidly maturing in multiple other indications.…”

The Clinical Impact of Comprehensive Genomic Testing of Circulating Cell-Free DNA in Advanced Lung Cancer

“…Specifically, cytotoxic chemotherapy is associated with a doubling of annual health care costs over erlotinib, and a four-fold increase when biologicals such as bevacizumab are included. 49 Secondly, EGFR, ALK, and ROS1 alterations are negative predictors of immunotherapy response, and when tissue genotyping is infeasible or incomplete, these genes can be assessed with cfDNA NGS. 50,51 This study extends the evidence for clinical utility of comprehensive plasma-based cfDNA NGS testing by showing durability of response.…”