ECONOMIC BURDEN OF INCIDENT BRAIN METASTASES IN MEDICARE BENEFICIARIES WITH ALK+ METASTATIC NON-SMALL CELL LUNG CANCER
Author(s)
Devin Abrahami, PhD1, Zachary Marcum, PharmD, PhD2, Andrew J. Epstein, PhD2, Matthew Davis, MA2, Robert Morlock, PhD3, Lindsay Stansfield, PharmD1, Priya Ramachandran, PharmD, MBA1, Benjamin Li, PhD1, Krishnan Ramaswamy, PhD1, Lyudmila Bazhenova, MD4;
1Pfizer Inc, New York, NY, USA, 2Medicus Economics, LLC, Milton, MA, USA, 3YourCareChoice, Ann Arbor, MI, USA, 4UC San Diego Moores Cancer Center, La Jolla, CA, USA
1Pfizer Inc, New York, NY, USA, 2Medicus Economics, LLC, Milton, MA, USA, 3YourCareChoice, Ann Arbor, MI, USA, 4UC San Diego Moores Cancer Center, La Jolla, CA, USA
OBJECTIVES: Development of brain metastases (BMs) is common and clinically consequential in patients with ALK+ metastatic non-small cell lung cancer (mNSCLC). The magnitude of the economic burden of BM development in older adults receiving ALK tyrosine kinase inhibitors (TKIs) is unknown. This study quantified BM-attributable cumulative healthcare spending among US Medicare beneficiaries with ALK+ mNSCLC treated with any first-line ALK TKI.
METHODS: We used 100% Medicare Parts A, B, and D claims (2016-2023) to identify beneficiaries aged >66 years with a lung cancer diagnosis and no baseline BM who initiated a first-line ALK TKI (alectinib, brigatinib, ceritinib, crizotinib, ensartinib, lorlatinib). Incident BM was defined as the first claim with ICD-10-CM code C79.31 following treatment initiation. A modified clone-censoring design aligned follow-up to BM onset and constructed BM and non-BM arms. Beneficiaries without observed BMs were assigned pseudo-BM dates based on the observed distribution of BM timing. Total direct spending (inflation-adjusted to 2023 dollars) included all Medicare, beneficiary, and third-party payments on medical and pharmacy claims. Incremental monthly BM-attributable spending was modeled with a log-gamma generalized estimating equation with an unstructured correlation matrix adjusted for baseline covariates. Analyses were conducted conditional on survival, and cumulative incremental spending was evaluated through month 48 after incident BM.
RESULTS: Among 985 eligible beneficiaries (mean age 76.0 years; 58.4% female; 75.8% non-Hispanic White), 194 (19.7%) experienced an incident BM. Conditional on survival, spending in the BM arm was consistently higher than in the non-BM arm. Cumulative incremental total spending attributable to BM was: $26,618 at 12 months (95% confidence interval [CI]: $8,389, $44,847), $47,343 at 24 months (95% CI: $7,793, $86,892), $59,978 at 36 months (−$2,457, $122,413), and $76,590 at 48 months (95% CI: −$4,880, $158,060).
CONCLUSIONS: Among Medicare beneficiaries with ALK+ mNSCLC, incident BMs are associated with substantial additional healthcare costs conditional on survival.
METHODS: We used 100% Medicare Parts A, B, and D claims (2016-2023) to identify beneficiaries aged >66 years with a lung cancer diagnosis and no baseline BM who initiated a first-line ALK TKI (alectinib, brigatinib, ceritinib, crizotinib, ensartinib, lorlatinib). Incident BM was defined as the first claim with ICD-10-CM code C79.31 following treatment initiation. A modified clone-censoring design aligned follow-up to BM onset and constructed BM and non-BM arms. Beneficiaries without observed BMs were assigned pseudo-BM dates based on the observed distribution of BM timing. Total direct spending (inflation-adjusted to 2023 dollars) included all Medicare, beneficiary, and third-party payments on medical and pharmacy claims. Incremental monthly BM-attributable spending was modeled with a log-gamma generalized estimating equation with an unstructured correlation matrix adjusted for baseline covariates. Analyses were conducted conditional on survival, and cumulative incremental spending was evaluated through month 48 after incident BM.
RESULTS: Among 985 eligible beneficiaries (mean age 76.0 years; 58.4% female; 75.8% non-Hispanic White), 194 (19.7%) experienced an incident BM. Conditional on survival, spending in the BM arm was consistently higher than in the non-BM arm. Cumulative incremental total spending attributable to BM was: $26,618 at 12 months (95% confidence interval [CI]: $8,389, $44,847), $47,343 at 24 months (95% CI: $7,793, $86,892), $59,978 at 36 months (−$2,457, $122,413), and $76,590 at 48 months (95% CI: −$4,880, $158,060).
CONCLUSIONS: Among Medicare beneficiaries with ALK+ mNSCLC, incident BMs are associated with substantial additional healthcare costs conditional on survival.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE253
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology