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

Abstract

Purpose: Advanced non-small-cell lung cancer (aNSCLC; stage IIIB/IV) presents a substantial clinical burden to society; reliable estimates of its economic burden are lacking. Therefore, this study aimed to quantify real-world health care resource utilization (HCRU) and costs of patients with squamous (SQ) and non-SQ (NSQ) aNSCLC who received two or more lines of treatment (2L+) in Europe, and to describe cost-predictors. Methods: The LENS (Leading the Evaluation of Non-squamous and Squamous NSCLC) retrospective chart review study collected data from 2L+ patients with aNSCLC diagnosed between 07/2009 and 08/2011 (wave 1) or 07/2010 and 09/2012 (wave 2) in France, Germany, Italy, Spain, England, the Netherlands, and Sweden. Patients were followed from diagnosis through most recent visit/death. A weighted average of countryspecific unit costs (2018 Euro) was applied to systemic anti-cancer therapy usage and HCRU (hospital/emergency department visit, surgery, radiotherapy, ancillary care, biomarker testing) to determine the total cost from aNSCLC diagnosis to death. Generalized linear models (gamma distribution, log link) were used to assess clinical and demographic predictors. Results: Of 973 2L+ aNSCLC patients, median overall survival (OS) was 1.5 years from advanced diagnosis (range: 0.2-5.3; median OS: 1.4 [SQ], 1.6 [NSQ]), 79.0% died during follow-up. Weighted mean total per-patient costs were €21,273, ranging from €17,761 (England) to €30,854 (Sweden), and €15,446 (SQ) to €26,477 (NSQ). Systemic drug costs comprised 77.4% of total costs. Insurance status, presence of epidermal growth factor receptor (EGFR) mutation, SQ histology, age, alcohol abuse, and year of diagnosis were significant predictors for lower total costs per patient-month, Eastern Cooperative Oncology Group performance status (ECOG PS) ≥1 and country for higher costs. Conclusion: In the era pre-immunotherapy, HCRU and costs were substantial in aNSCLC 2L+ patients, with most of the costs accrued prior to start of 2L. NSQ patients incurred significantly higher total costs than SQ patients in all participating countries.

Economic burden of lung cancer in Turkey: a cost of illness study from payer perspective

“…Our findings related to total per patient annual direct medical cost for SCLC and NSCLC, total annual direct non-medical cost, total annual indirect medical cost, and total economic burden of lung cancer confirm the consistently reported real-world data on the substantial economic burden of lung cancer to the healthcare system [ 9 – 11 ].…”

“…Likewise, largest cost drivers in NSCLC patients were reported to be associated with therapies received (€12,375 France; €3694 UK) and hospitalization/emergency costs (€7706 Germany) [ 11 ], while the main cost drivers (total cost: $45,897) in lung cancer in the USA was reported as hospitalization (49.0%) and outpatient office visits (35.2%) [ 30 ]. The systemic anti-cancer medication was reported as the main cost driver that comprise 77.4% of total costs in a multinational European study [ 9 ], and noted as the key cost driver in studies from Italy (€25,859) [ 31 ] and the Netherlands (€17,463) [ 32 ].…”

“…Although the economic burden of lung cancer has been addressed by a relatively large amount of research, most of the studies have focused on NSCLC and direct costs related to the chemotherapy [ 9 – 11 ]. Accordingly, the available data are limited regarding the reliable estimates of the economic burden of lung cancer as well as the sufficient information on the drivers of the costs [ 9 – 11 ]. Moreover, the economic burden of lung cancer differs across countries depending on the economic development level, healthcare systems and purchasing power [ 12 , 13 ].…”

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

“…Different studies have assessed the costs of managing lung cancer in specific European contexts [ 2 , 8 , 22 , 50 , 58 , 59 , 60 , 61 ]. However, it is difficult to compare their results with ours due to differences in the study approach, the unit prices of the procedures and the reimbursed prices of the drugs.…”

Economic burden of locoregional and metastatic relapses in resectable early-stage non-small cell lung cancer in Spain

“…Cancer cost the European Union €126 billion in 2009, and lung cancer had the highest economic cost (15% of overall cancer cost) [ 22 ]. Although the clinical burden of the disease is well known, there are few real-world data on the economic impact [ 23 ]. So, despite the high incidence and clinical burden of NSCLC, and the fact that relapse is the main cause of mortality during postresectional treatment, data on the cost of disease recurrence in Spain are scarce.…”