Real-World Treatment Patterns, Overall Survival, and Occurrence and Costs of Adverse Events Associated With Second-Line Therapies for Medicare Patients With Advanced Non–Small-Cell Lung Cancer

Arunachalam, Ashwini; Li, Haojie; Bittoni, Marisa; Camacho, Ramon; Cao, Xiting; Zhong, Yichen; Lubiniecki, Gregory M.; Carbone, David P.

doi:10.1016/j.cllc.2018.05.016

Cited by 39 publications

(36 citation statements)

References 30 publications

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“…We cannot draw conclusions with regard to these excluded patients, as we aimed to observe aNSCLC patients only. As the characteristics of our sample are well in line with previous clinical and observational studies with respect to age, gender distribution and percentage of IIIb/IV patients [27][28][29], we nevertheless interpret our results to be generalizable with regard to treatment and OS of aNSCLC patients in Germany.…”

Section: Discussionsupporting

confidence: 88%

Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

Myers

Cizova

et al. 2020

BMC Cancer

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Background: The objective of this study was to describe the real-world treatment and overall survival (OS) of German patients with a diagnosis of advanced non-small cell lung cancer (aNSCLC), and to explore factors associated with the real-world mortality risk. Methods: This was a retrospective German claims data analysis of incident aNSCLC patients. Data were available from 01/01/2011 until 31/12/2016. Identification of eligible patients took place between 01/01/2012-31/12/2015, to allow for at least 1-year pre-index and follow-up periods. Inpatient and outpatient mutation test procedures after aNSCLC diagnosis were observed. Further, prescribed treatments and OS since first (incident) aNSCLC diagnosis and start of respective treatment lines were described both for all patients and presumed EGFR/ALK/ROS-1-positive patients. Factors associated with OS were analyzed in multivariable Cox regression analysis. Results: Overall, 1741 aNSCLC patients were observed (mean age: 66•97 years, female: 29•87%). The mutation test rate within this population was 26•31% (n = 458), 26•6% of these patients (n = 122) received a targeted treatment and were assumed to have a positive EGFR/ALK/ROS-1 test result. Most often prescribed treatments were pemetrexed monotherapy as 1 L (21•23% for all and 11•11% for mutation-positive patients) and erlotinib monotherapy as 2 L (25•83%/38•54%). Median OS since incident diagnosis was 351 days in all and 571 days in mutation-positive patients. In a multivariable Cox regression analysis, higher age, a stage IV disease, a higher number of chronic drugs in the pre-index period and no systemic therapy increased the risk of early death since first aNSCLC diagnosis. On the other hand, female gender and treatment with therapies other than chemotherapy were associated with a lower risk of early death. Conclusions: Despite the introduction of new treatments, the real-world survival prognosis for aNSCLC patients remains poor if measured based on an unselected real-world population of patients. Still, the majority of German aNSCLC patients do not receive a mutation test.

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Section: Discussionsupporting

confidence: 88%

Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

Myers

Cizova

et al. 2020

BMC Cancer

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“…These real-world data show survival estimates lower than in RCTs for the control group, with a median overall survival ranging from 4.3 months (95% CI 3.9-5.2 months) in second-line therapy for nonsquamous NSCLC to 6.4 months (95% CI 5.9-7.2 months) in first-line therapy versus 9.4 months (95% CI 8.1-10.7 months) to ∼8.5 months in second-line RCTs [4][5][6] and not reached in first line [3]. However, our data are consistent with other worldwide, real-world data [19][20][21][22]. Third, we used microsimulation, an innovative method, to combine real-world data from the ESCAP-2011-CPHG cohort study [12] with unbiased estimates of treatment effects from RCTs.…”

Section: Discussionsupporting

confidence: 90%

A microsimulation model to assess the economic impact of immunotherapy in non-small cell lung cancer

et al. 2020

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IntroductionImmunotherapy has become the standard of care in advanced non-small cell lung cancer (NSCLC). We aimed to quantify the economic impact, in France, of anti-PD-1 therapy for NSCLC.MethodsWe used patient-level data from the national ESCAP-2011-CPHG cohort study to estimate time to treatment failure and mean cost per patient for the four label indications approved by the European Medicines Agency (EMA) for NSCLC in May 2018. To compute the budget impact, we used a microsimulation model to estimate the target populations of anti-PD-1 therapy over a 3-year period, which were combined with the annual cost of treatment.ResultsOverall, 11 839 patients with NSCLC were estimated to be eligible for anti-PD-1 therapy 3 years after the introduction of anti-PD-1 therapies. The mean annual cost per patient in the control group ranged from €2671 (95% CI €2149–3194) to €6412 (95% CI €5920–6903) across the four indications. The mean annual cost of treatment for the four EMA-approved indications of anti-PD-1 therapy was estimated to be €48.7 million in the control group and at €421.8 million in the immunotherapy group. The overall budget impact in 2019 is expected to amount to €373.1 million. In the sensitivity analysis, flat doses and treatment effect had the greatest influence on the budget impact.ConclusionAnti-PD-1 agents for NSCLC treatment are associated with a substantial economic burden.

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“…Very few publications report real-life treatment patterns and/or costs in R/ M SCCHN 24,25 rendering comparison with foreign results difficult and not very useful although numerous articles describe detailed parts of the costs 26 . However, several articles describe similar findings for other cancers 27 such as lung cancer 28,29 and melanoma 30 , showing a growing interest for these types of studies.…”

Section: Journal Of Medical Economicsmentioning

confidence: 78%

Economic burden of chemotherapy-treated recurrent and/or metastatic squamous cell carcinoma of the head and neck in France: real-world data from the permanent sample of national health insurance beneficiaries

Lafuma

Cotté

Tourneau

et al. 2019

Journal of Medical Economics

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Real-World Treatment Patterns, Overall Survival, and Occurrence and Costs of Adverse Events Associated With Second-Line Therapies for Medicare Patients With Advanced Non–Small-Cell Lung Cancer

Abstract: These real-world data illustrate the variety of second-line regimens, poor prognosis, and high cost of second-line chemotherapy for patients with advanced NSCLC treated before the approval of immunotherapies for these patients.

Cited by 39 publications

References 30 publications

Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

A microsimulation model to assess the economic impact of immunotherapy in non-small cell lung cancer

Economic burden of chemotherapy-treated recurrent and/or metastatic squamous cell carcinoma of the head and neck in France: real-world data from the permanent sample of national health insurance beneficiaries

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