Real-World Health Care Resource Utilization and Related Costs Among Patients Who Received At Least Two Lines of Treatment for Advanced Nsclc in England, The Netherlands, and Sweden

• Published in: Value in health 2017-10, Vol.20 (9), p.A431
• Main Authors: Solem, CT, Penrod, JR, Lees, M, Macahilig, C, Luo, L, Verleger, K, Manley Daumont, M, Hertel, N
• Format: Article
• Language: English
• Subjects: Biological markers; Cancer therapies; Chart reviews; Death; Death & dying; Diagnosis; Drug prices; Health care expenditures; Health services utilization; Help seeking behavior; Home health care; Hospitalized; Immunotherapy; Lung cancer; Medical diagnosis; Non-small cell lung carcinoma; Nursing homes; Oncology; Patients; Radiation therapy; Radiotherapy; Resource utilization; Surgery
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.192

OBJECTIVES: Advanced (stage IIIb/IV) non-small cell lung cancer (aNSCLC) presents a high burden to society. This study aimed to quantify real-world health care resource utilization (HRCU) and related costs of patients with squamous (SQ) and non-SQ (NSQ) aNSCLC who received ≥2 lines of treatment (2L+) in England, the Netherlands, and Sweden. METHODS: Within wave 2 of the 7-country Leading the Evaluation of NSQ and SQNSCLC (LENS) retrospective chart review study, patients diagnosed with aNSCLC between 07/2010-09/2012 who initiated 2L were sampled from oncology/pulmonology practices and followed from diagnosis through most recent visit/death. HRCU (aNSCLC-related hospital/ER visits, surgeries, radiotherapy, ancillary care [hospice, nursing home, in-home], biomarker tests) and systemic treatment use was extracted from medical charts. Country-specific unit costs, inflated to 20166, were multiplied by HCRU to derive aNSCLC-related costs. RESULTS: Of 138 patients (n=52 England, 57 Netherlands, 29 Sweden; n=42 SQ, 96 NSQ), 95.7% were followed through death (median observation time: 16.5 months [4.0-68.6]). From diagnosis through most recent visit/death, 44.2% of patients were hospitalized (median duration: 0.8 days/patient-month); 25.4% had ≥1 ER visit; 44.9% radiotherapy; 3.4% surgery; 23.2% received ancillary care. Median total per-patient costs were €8,431 per SQ (€6,442 England; €10,577 Netherlands; €11,857 Sweden) and €15,989 per NSQ patient (€6,442 England, €26,647 Netherlands, €27,909 Sweden). Drug costs accounted for48.5%/52.1%/48.4% of total median overall/SQ/NSQ costs, and were highest/lowest in Netherlands/England. During the last month of life, median costs were €939/2,032 per SQ/NSQ patient, with hospice presenting the largest cost portion. CONCLUSIONS: Prior to availability of immunotherapy, HCRU and costs were substantial in aNSCLC patients, with systemic treatment accounting for 48.5% of total median costs. NSQ patients incurred higher total costs than SQ patients in Sweden and the Netherlands, and similar costs in England. Ongoing real-word data are needed to capture changes in HCRU patterns due to the evolving NSCLC treatment landscape.