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

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 country-specific 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.

Keywords:

• carcinoma
• non-small-cell lung
• observational study
• cost of illness
• health care costs

Acknowledgments

This study was funded by Bristol-Myers Squibb. Two abstracts of this paper were presented at the ISPOR 20th Annual European Congress as a poster presentation with interim findings.²¹⁻²³

Author Contributions

Nadine Hertel and Caitlyn Solem directed the study activities. Melinda Manley Daumont, Cynthia Macahilig, and John R Penrod contributed to the study design and interpretation. Linlin Luo performed the analysis for this manuscript. Katharina Verleger supported all project phases, drafted the manuscript and designed the figures and tables. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Katharina Verleger, Caitlyn Solem, and Linlin Luo are employees of Pharmerit, which was contracted by Bristol-Myers Squibb to conduct the retrospective chart review study. Cynthia Macahilig is an employee of Medical Data Analytics, which was contracted by Bristol-Myers Squibb to collect and consolidate the data for this study. Nadine Hertel, Melinda Manley Daumont, and John R Penrod are employees of Bristol-Myers Squibb, a global biopharmaceutical company that researches and develops medicines for NSCLC. The authors report no other conflicts of interest in this work.