TIMING OF ADJUVANT THERAPY AND TOTAL HEALTHCARE EXPENDITURES FOLLOWING ROBOTIC-ASSISTED LOBECTOMY OF NON-SMALL CELL LUNG CANCER: A SEER-MEDICARE ANALYSIS
Author(s)
Gediwon Milky, MS, PhD1, Tessa Runels, MPH2, I-Fan Shih, PhD3.
1Global Access, Value & Econmoics, Intuitive Surgical, Sunnyvale, CA, USA, 2Intuitive Surgical, New York, NY, USA, 3Intuitive Surgical, Sunnyvale, CA, USA.
1Global Access, Value & Econmoics, Intuitive Surgical, Sunnyvale, CA, USA, 2Intuitive Surgical, New York, NY, USA, 3Intuitive Surgical, Sunnyvale, CA, USA.
OBJECTIVES: Robotic-assisted surgery (RAS) for lung cancer resections is increasingly used and associated with faster recovery, but its impact on patient readiness for adjuvant systemic therapy and downstream healthcare expenditures remains unclear. We examined early adjuvant therapy and one-year expenditures following RAS versus Video-Assisted Thoracoscopic (VATS) and Open resections.
METHODS: The Surveillance, Epidemiology, and End Results-Medicare claims database was queried for patients who had lobectomy between January 2016 and December 2019. Primary outcome was rate of adjuvant therapy started at 6-weeks, 8-weeks and 10-weeks post-surgery. Secondary outcome was one-year total healthcare expenditure after surgery. Inverse-probability of treatment weighted generalized linear models were used to compare RAS versus VATS and Open resection.
RESULTS: A total of 4,281 patients who had lobectomy were included (893 [21%] RAS, 2,270 [53%] VATS and 1,118 [26%] Open). As compared to Open, RAS lobectomy was associated with 34% greater likelihood of adjuvant therapy timing at 6-weeks postop (18.0% vs 14.1%, OR=1.34, p= 0.019) and an average of $6,980 lower postop one-year expenditure (95% CI= -$10,847 to -$3,114, p< .001). RAS and VATS had no significant difference in adjuvant therapy timing and one-year postop expenditure (all p > 0.05). In a subgroup of patients with stage-I cancer at diagnosis, RAS was associated with greater likelihood of starting adjuvant therapy at 8-weeks (OR= 1.42, p= 0.023) and at 10-weeks postop (OR= 1.41, p= 1.18), with no difference in one-year postop expenditures (p= 0.20).
CONCLUSIONS: RAS lobectomy is associated with earlier timing of adjuvant therapy and lower one-year expenditure as compared to Open lobectomy.
METHODS: The Surveillance, Epidemiology, and End Results-Medicare claims database was queried for patients who had lobectomy between January 2016 and December 2019. Primary outcome was rate of adjuvant therapy started at 6-weeks, 8-weeks and 10-weeks post-surgery. Secondary outcome was one-year total healthcare expenditure after surgery. Inverse-probability of treatment weighted generalized linear models were used to compare RAS versus VATS and Open resection.
RESULTS: A total of 4,281 patients who had lobectomy were included (893 [21%] RAS, 2,270 [53%] VATS and 1,118 [26%] Open). As compared to Open, RAS lobectomy was associated with 34% greater likelihood of adjuvant therapy timing at 6-weeks postop (18.0% vs 14.1%, OR=1.34, p= 0.019) and an average of $6,980 lower postop one-year expenditure (95% CI= -$10,847 to -$3,114, p< .001). RAS and VATS had no significant difference in adjuvant therapy timing and one-year postop expenditure (all p > 0.05). In a subgroup of patients with stage-I cancer at diagnosis, RAS was associated with greater likelihood of starting adjuvant therapy at 8-weeks (OR= 1.42, p= 0.023) and at 10-weeks postop (OR= 1.41, p= 1.18), with no difference in one-year postop expenditures (p= 0.20).
CONCLUSIONS: RAS lobectomy is associated with earlier timing of adjuvant therapy and lower one-year expenditure as compared to Open lobectomy.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO142
Topic
Clinical Outcomes
Topic Subcategory
Relating Intermediate to Long-term Outcomes
Disease
SDC: Oncology