LAUSR

Background: The objective of this review was to examine the economic and health care resource utilization (HCRU) burden of patients with metastatic non-small cell lung cancer (mNSCLC), globally. Methods: A systematic literature review of PubMed and Embase between 9/28/2016 and 9/28/2021 was conducted. Studies reporting on the economic burden (direct or indirect) and/or HCRU burden of patients with mNSCLC were included in this review. Results: Eighteen studies were included in this review (Table 1). Direct healthcare costs for mNSCLC patients ranged from $10,055 to $18,565 per patient per month (PPPM) in the US and €1941 (UK) - €3151 (France) in Europe. While anticancer drugs generally made up a significant percentage of costs, medical management costs were also substantial and, in some cases, exceeded anticancer drug costs. End-of-life (EoL) costs per patient per month in a US claims database ranged from $15,160 (≥65 years) to $31,137 (<65 years). EoL costs were driven by hospitalization and IV drug administration costs. The incremental PPPM cost of any serious adverse event (SAE) in mNSCLC was substantial, with an additional $4700 for patients with any SAE. Mean AE-related costs ranged from $16,319 on immunotherapy to $23,009 on chemotherapy. Chemotherapy-alone was found to be associated with higher rates of AE-related ambulatory, ER, and inpatient visits. Total healthcare costs were significantly higher for patients initiating guideline-recommended therapies compared to non-guideline recommended therapies. Lifetime direct medical costs were higher for patients participating in clinical trials compared to non-trial participants. Conclusions: Given the substantial burden of mNSCLC, there were few studies examining the economic and/or HCRU burden. New therapeutic options with clinical efficacy and the potential to reduce overall healthcare cost would provide a high level of value. Table 1. Description of Studies STUDY TYPE COUNTRY DATA SAMPLE (N) TIME PERIOD PATIENT POPULATION Veraldi et al. 2022 Retrospective Italy Medical records, internal prescription cards and reports of adverse reactions 102 9/2016–9/2020 mNSCLC Chou et al. 2021 Retrospective USA US claims database 10075, 11/2016–9/2019 mNSCLC Lester-Coll et al. 2021 Retrospective USA SEER-Medicare 215 2004–2014 mNSCLC w/SBRT as 1L Cramer-van der Welle et al. 2021 Retrospective Netherlands Five Dutch large teaching hospitals (Santeon network) 1214 2008–2014 Stage IV NSCLC treated w/systemic therapy Merkhofer et al. 2020 Retrospective USA EHR Linked to Tumor Registry and Claims Data at the Seattle Cancer Care Alliance 101 2007–2015 mNSCLC (clinical trial vs. nonclinical trial participants) Matsuda et al. 2020 Retrospective USA Medicare FFS Claims and PROGNOS NSCLC Explorer Dataset 438 7/2014–6/2018 mNSCLC, a positive KRAS biomarker test result, and anti-cancer treatment Engel-Nitz et al. 2020 Retrospective USA Medicare Advantage 9712 1/2008–3/2018 mNSCLC with first-line, nontargeted systemic anti-NSCLC therapy Garon et al. 2020 Clinical Trial USA REVEL trial 1253 N/R Stage IV NSCLC with disease progression on platinum-based therapy Engel-Nitz et al. 2019 Retrospective USA Commercial and Medicare Advantage Claims 9712 1/2008–2/2018 mNSCLC with systemic therapy (immunotherapy or chemotherapy) Lejeune et al. 2019 Retrospective USA IQVIA™ Real-World Data Adjudicated Claims - U.S. database 1646 Q2/2012–Q1/2017 mNSCLC with EGFR-TKI as 1L treatment Subramanian et al. 2019 Retrospective USA IQVIA™ Real-World Data Adjudicated Claims - US database 1646 04/2012– 03/2017 mNSCLC with EGFR-TKI as 1L treatment Cramer-van der Welle et al. 2019 Retrospective Netherlands Five Dutch large teaching hospitals (Santeon network) 983 2008–2014 Stage IV NSCLC treated w/systemic therapy Subramanian et al. 2018 Retrospective USA IQVIA™ Real-World Data Adjudicated Claims - US database 1646 Q2/2012– Q1/2017 mNSCLC with EGFR-TKI as 1L treatment Casebeer et al. 2018 Retrospective USA Humana Claims and Treatment Authorizations (Medicare Patients) 1344 2013–2014 mNSCLC w/infusion therapy Kurosky et al. 2017 Retrospective UK, Spain, Germany, and France Medical Records Review 821 1/2008 and 12/2014 (UK)/1/2015 (SP, GE)/10/2015 (FR) mNSCLC initiating second-line treatment Crane et al. 2017 Retrospective Germany and France Validated Questionnaires and Patient Charts 123 Data cutoff: 5/29/2017 mNSCLC with and without CNS mets Lorenzo et al. 2016 Retrospective UK, Spain, Germany, and France Chart Review 818 1/2010–1/2014 Metastatic squamous NSCLC Casebeer et al. 2016 Retrospective USA Humana Claims and Treatment Authorizations 1458 2013–2014 mNSCLC w/infusion therapy Citation Format: Cloe Koh, Wesley Furnback, Gordon Chavez, Chelsea Higgins, Jin Kim, Christina Proescholdt. The economic and healthcare resource utilization of metastatic non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 729.