Real world treatment patterns, healthcare resource use and costs in patients with advanced or metastatic non-small cell lung cancer by EGFR mutation type

Abstract

Aims

This study described treatment patterns, healthcare resource utilization (HRU) and costs among advanced or metastatic non-small cell lung cancer (a/mNSCLC) patients with different epidermal growth factor receptor (EGFR) mutation types.

Materials and methods

This retrospective study leveraged NeoGenomics NeoNucleus linked with IQVIA PharMetrics Plus between 01 January 2016 to 30 April 2021 (study period). Patients with evidence of a/mNSCLC between 01 July 2016 to 31 March 2021 (selection window) with EGFR test results indicating exon 19 deletion (exon19del), exon 21 L858R (L858R), or exon 20 insertion (exon20i) mutations were included; date of first observed evidence of a/mNSCLC was the index date. Treatment patterns, all-cause HRU and costs during ≥1 month follow-up were reported for each cohort (exon19del, L858R, and exon20i).

Results

A total of 106 exon19del, 75 L858R, and 13 exon20i patients met the study criteria. The prevalence of hospitalization was highest in the exon20i cohort (76.9%), followed by L858R (62.7%) and exon19del (55.7%) cohorts. A higher proportion of patients had evidence of hospice/end-of-life care in the exon20i (30.8%) and L858R (29.3%) cohorts relative to the exon19del cohort (22.6%). The exon20i cohort had higher median total healthcare costs per patient per month ($27,069) relative to exon19del ($17,482) and L858R ($17,763). EGFR tyrosine kinase inhibitors (TKI) were the most frequently observed treatment type for exon19del and L858R cohorts, while chemotherapy was the most observed treatment in exon20i cohort.

Limitations

The sample size for the study cohorts was small, thus no statistical comparisons were conducted.

Conclusions

This is one of the first real-world studies to describe HRU and costs among a/mNSCLC patients by specific EGFR mutation type. HRU and costs varied between EGFR mutation types and were highest among exon20i cohort, potentially reflecting higher disease burden and unmet need among patients with this mutation.

PLAIN LANGUAGE SUMMARY

Patients with non-small cell lung cancer (NSCLC) in an advanced or metastatic stage (a/mNSCLC) where cancer has spread to other parts of the body have high chance of dying within five years. Treatment and management of a/mNSCLC also incurs significant healthcare resource utilization (HRU) and costs. Patients with a/mNSCLC may have their epidermal growth factor receptor (EGFR) gene mutated with different variations. Our study described what a/mNSCLC patients were treated with, their HRU and healthcare costs separately for the following three types of EGFR mutations: exon 19 deletion (exon19del), exon 21 L858R (L858R), or exon 20 insertion (exon20i). Our study found that patients with exon19del or L858R mutation were commonly treated with EGFR tyrosine kinase inhibitors (TKIs), while exon20i patients were mostly treated with chemotherapy due to lack of targeted treatment for exon20i during the time when the study was conducted. HRU and healthcare costs were highest for patients with exon20i, which shows that patients with exon20i face high burden and have a need for new treatment options.

Keywords:

• Exon 20 insertion
• EGFR mutations
• exon 19 deletion
• L858R mutation
• non-small cell lung cancer
• treatment pattern
• healthcare resource utilization

JEL CLASSIFICATION CODES:

• I11
• I1
• I
• I10

Transparency

Declaration of funding

This study was supported by Janssen Scientific Affairs, LLC (Horsham, PA, USA).

Declaration of financial/other relationships

PV, DW and JV are employees of Janssen Scientific Affairs10.13039/100017183, LLC. IL, JC, DT and AN are employees of IQVIA, which received funding for this study from Janssen Scientific Affairs10.13039/100017183, LLC. DL is employee of NeoGenomics, which received part of the research funding Janssen provided to IQVIA. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article and take responsibility for the integrity of the work as a whole. IL and JC drafted the manuscript, and all authors critically revised the manuscript. All authors read and approved the final manuscript.

Acknowledgements

No assistance in the preparation of this article is to be declared.

Data availability statement

The original de-identified data used in this analysis were obtained from and are the property of IQVIA and NeoGenomics. IQVIA and NeoGenomics have restrictions prohibiting the authors from making the data set publicly available. Interested researchers may contact IQVIA/NeoGenomics to apply to gain access to the study’s data in the same way the authors obtained the data (see https://www.iqvia.com/contact/sf or https://neogenomics.com/contact-us).

Previous presentations

Part of this research was presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2023.