Cost of Care for mNSCLC Burdens Healthcare System and Patients

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In the United States (US), metastatic non–small cell lung cancer (mNSCLC) is associated with a significant financial burden which impacts the healthcare system and patients, according to a retrospective observational cohort study for which results were presented during the International Society for Pharmacoeconomics and Outcomes Research (iSPOR) 2023 Meeting.¹

Findings from the study show that the period of the highest financial burden is the period between diagnosis and the start of first treatment. Moreover, patients with Medicaid had lower healthcare costs compared with patients who had commercial insurance, regardless of the number of claims.

The mean total per-patient-per-month (PPPM) cost of care with commercial insurance during the period from diagnosis to first treatment was $64,253 (95% CI, $60,042 to $68,463). The cost of care during this period was predominately from medical expenses ($61,824; 95% CI, $57,650 to $65,997), and $2,429 (95% CI, $2,032 to $2,826) of the expenses were pharmacy-related. With public insurance, the mean total PPPM cost was $34,937 (95% CI, $34,030 to $35,843) of which $32,321 (95% CI, $31,430 to $33,212) was from medical expenses, and $2,615 (95% CI, $2,490 to $2,742) was pharmacy-related.

Although NSCLC is one of the most common forms of cancer in the US, most patients present with metastatic disease that is negative for EGFR or ALK mutations, which would make them eligible for EGFR or ALK inhibitor therapy, according to the study investigators. Multiple new treatments have been granted FDA approval for the treatment of mNSCLC, but little information is available on the healthcare resource utilization of these therapies and the cost of care.

To provide this much-needed information, investigators reviewed data from 8,234 patients with mNSCLC without an EGFR or ALK mutation. All patients had been diagnosed with mNSCLC between 2017 and 2021, and had received prior chemotherapy, immunotherapy, or targeted therapy in the first-line setting using the Optum Clinformatics US platform. Patients were included if they had more than 2 insurance claims in the system. The cost of care and use of healthcare resource was assessed during different phases of care. The phases include pre-diagnosis, the time from diagnosis to first treatment (period 1), first treatment (period 2) post-first treatment (period 4), and end of life care (period 4).

At baseline, patients had a median age of 71 years (IQR, 65-77 years), and the population was 47.4% female and 52.2% male. Over 73% of patients identified as White, while Black, Hispanic, and Asian patients made up 11.7%, 7.0%, and 2.1%, respectively.

Other baseline statistics showed that 80.9% of patients had Medicaid as their insurer, 65.7% had commercial insurance, and 0.3% had both. The median number of comorbidities among patients was 7 comorbidities (IQR, 6-8) on the Charlson comorbidity scale. Overall, 92.0% of the population had 5 or more comorbidities. Patients from the south made up 44.1% of the study population while 26.7%, 15.0%, and 14.0% were from the Midwest, West, and Northeast, respectively. Seventy percent of patients died during follow-up.

Results showed that during period 1, patients had the most ambulatory visits, inpatient visits, and other insurance claims than all other periods, which contributed to the higher healthcare costs. In comparison, the mean total PPPM cost with commercial insurance during period 2 was $44,210 (95% CI, $42,255 to $46,264) with $20,180 (95% CI, $18,504 to %21,855) being medical and $24, 030 (95% CI, $22,999 to $25,061) being pharmacy-related. Among those with public insurance, the mean total cost PPPM was $36, 717 (95% CI, $35,658 to $37,777) of which $13,519 (95% CI, $12,933 to $14,106) was medical, and $23,198 (95% CI, $22,346 to $24,050) was pharmacy-related.

During period 3, the mean total cost PPPM for patients with commercial insurance was $23, 512 (95% CI, $21, 905 to $25,118). Medical costs made of $10,479 (95% CI, $9,548 to $11,410) of the total cost, and pharmacy expenses made of $13,032 (95% CI, $11,764 to $14, 301). Among those with Medicaid, the mean total cost PPPM was $16, 938 (95% CI, $16,296 to $17,579) consisting of $8,001 (95% CI, $7,542 to $8,459) in medical expenses and $8,937 (95% CI, $8,494 to $9,380) in pharmacy expenses.

The period mean total cost PPPM for commercial insurance holders was $24,117 (95% CI, $22,205 to $26,030), of which $18,613 (95% CI, $17,013 to $20,213) came from medical expenses, and $5,505 (95% CI, $4,853 to $6,157) came from pharmacy expenses. Patients with public insurance had mean total cost PPPM of $18,148 (95% CI, $17,528 to $18,768), with $13,756 (95% CI, $13,208 to $14,304) being medical and $4,492 (95% CI, $4,178 to $4,606) being pharmacy related. Notably, the least number of claims for ambulatory visits, inpatients visits, and other claims were observed during this period and contributed to the low cost of care.

According to the study investigators, this research may be useful for economic modeling of therapies developed from NSCLC in the future.

_REFERENCES:

_{Simmon D, Welch E, Jiang Z, et al. The economic burden of metastatic non-small cell lung cancer in US patients without an EGFR or ALK mutation. Presented at: 2023 International Society for Pharmacoeconomics and Outcomes Research; May 7-10, 2023. Boston, MA.}