Changes in Treatment Patterns and Costs for Lung Cancer Have Not Resulted in Relevant Improvements in Survival: A Population-Based Observational Study in Catalonia

Abstract

Objective: Few published studies have described multidisciplinary therapeutic strategies for lung cancer. This study aims to describe the different approaches used for treating lung cancer in Catalonia in 2014 and 2018 and to assess the associated cost and impact on patient survival. Methods: A retrospective observational cohort study using data of patients with lung cancer from health care registries in Catalonia was carried out. We analyzed change in treatment patterns, costs and survival according to the year of treatment initiation (2014 vs. 2018). The Kaplan–Meier method was used to estimate survival, with the follow-up until 2021. Results: From 2014 to 2018, the proportion of patients undergoing surgery increased and treatments for unresectable tumors decreased, mainly in younger patients. Immunotherapy increased by up to 9% by 2018. No differences in patient survival were observed within treatment patterns. The mean cost per patient in the first year of treatment increased from EUR 14,123 (standard deviation [SD] 4327) to EUR 14,550 (SD 3880) in surgical patients, from EUR 4655 (SD 3540) to EUR 5873 (SD 6455) in patients receiving curative radiotherapy and from EUR 4723 (SD 7003) to EUR 6458 (SD 10,116) in those treated for unresectable disease. Conclusions: From 2014 to 2018, surgical approaches increased in younger patients. The mean cost of treating patients increased, especially in pharmaceutical expenditure, mainly related to the use of several biomarker-targeted treatments. While no differences in overall patient survival were observed, it seems reasonable to expect improvements in this outcome in upcoming years as more patients receive innovative treatments.

Evolution of Diagnoses, Survival, and Costs of Oncological Medical Treatment for Non-Small-Cell Lung Cancer over 20 Years in Osona, Catalonia

“…This analysis reveals a noteworthy increase in survival in the latest period (2017-2021), coinciding with the introduction of immunotherapy as a treatment modality. In contrast, previous studies in our region did demonstrate similar survival differences after the implementation of immunotherapy, potentially attributed to the short follow-up time after treatment administration [23]. We did not observe a statistically significant increase in survival during the initial three periods analyzed (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).…”

“…In our region, only one previous study has been conducted to assess the cost of medical treatment and changes in survival among NSCLC patients based on data from tumor registries. This particular study observed an increase in treatment cost over a four-year period from 2014 to 2018 and did not show significant differences in survival rates [23].…”

“…Two previous studies conducted in Catalonia reported similar trends recently. One of them showed an increase from EUR 2923 per patient in 2014 to EUR 12,211 in 2018 [23], and the most recent one reported an increase from EUR 3545 per patient in 2010 to EUR 8371 in 2019 [60]. Our calculations may be influenced by a small number of patients receiving treatment with expensive immunotherapy agents, either alone or in combination with chemotherapy, and this is a possible explanation for discrepancies with the mentioned studies and the peak in costs observed in 2017 (see Figure 2B).…”