Cost Variation Across Lung-Cancer Diagnostic-Pathway Clusters: A Nationwide Real-World Analysis of 18,569 French Patients
Author(s)
Arnaud Panes, PharmD, PhD1, Helene Denis, PharmD2, Lionel Bensimon, MSc3, Isabelle Durand-Zaleski, MPP, PhD, MD4, Laurent Greillier, MD5, Pascal-Alexandre Thomas, MD6, Marie Wislez, MD7, Alice Brouquet, MSc2, Marion Apert, MS3, Valérie Guimard, MD3, Christine Le Bihan Benjamin, MD, PhD8, Marion Narbeburu, PhD8, Christos CHOUAID, MD9.
1Artificial intelligence and cancers association, Paris, France, 2Heva, Lyon, France, 3MSD France, Puteaux, France, 4Assistance Publique Hopitaux de Paris URCEco, Paris, France, 5Assistance publique - Hôpitaux de Marseille, Marseille, France, 6Department of Thoracic Surgery and Oesophageal Diseases, Hopital-Nord-APHM, Aix-Marseille University, Marseille, France, 7Oncology Thoracic Unit Pulmonology Department, AP-HP, Hôpital Cochin, Paris, France, 8French National Cancer Institute, Boulogne-Billancourt, France, 9Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
1Artificial intelligence and cancers association, Paris, France, 2Heva, Lyon, France, 3MSD France, Puteaux, France, 4Assistance Publique Hopitaux de Paris URCEco, Paris, France, 5Assistance publique - Hôpitaux de Marseille, Marseille, France, 6Department of Thoracic Surgery and Oesophageal Diseases, Hopital-Nord-APHM, Aix-Marseille University, Marseille, France, 7Oncology Thoracic Unit Pulmonology Department, AP-HP, Hôpital Cochin, Paris, France, 8French National Cancer Institute, Boulogne-Billancourt, France, 9Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
OBJECTIVES: Pre-treatment diagnostic-care pathways may drive heterogeneity in healthcare costs. We quantified how data-driven diagnostic-care pathway clusters relate to healthcare resource use and reimbursed costs during the 12 months preceding primary lung-cancer therapy (surgery or systemic treatment) in the 2018-2019 French national claims database.
METHODS: Finite-mixture models were applied separately to local/locally-advanced (LLC) or advanced/metastatic (AMC) patients in the French Cancer cohort (FCC), an extract of the French healthcare claims database, using all reimbursed activity in the 12 months before lung cancer treatment (systemic or surgery) Resource use was categorised as inpatient stays, hospital-dispensed drugs, outpatient professional services, community-pharmacy drugs, medical transport and sick-leave indemnities. Median (Q1;Q3) cost per patient (€2023), was reported.
RESULTS: Four pre-treatment care-consumption trajectories were identified—early, late, continuous, and last-minute. Among LLC patients (n=6,964) we observed an early cluster (n=3,444, 49%) and a late cluster (n=2,617, 38%), distinguished by care escalation 6 versus ≤ 3 months before treatment; a continuous cluster with steady year-round use (n=378, 5%); and a last-minute cluster with minimal pre-cancer care (n=525, 8%). AMC patients (n=11,605) displayed analogous late (n=9,491, 82%), continuous (n=1,170, 10%) and last-minute (n=944, 8%) trajectories, with no early cluster detected. In LLC, median total cost was €3,913 (1,063;9,994) for the last-minute cluster, €5,788 (3,441;11,258) , €5,852 (2,906;12,580) for the two standard clusters, and €10,704 (6,043;19,551) for the continuously-followed cluster. Hospitalisation spend rose from €1,634 (469;5,37) to €3,469 (1,084;9,217).For AMC, the last-minute cluster averaged €1,506 (487;5,489), the standard cluster €8,807 (4,663;16,493), and the continuously-followed cluster €11,814 (6,793;20,214). The median cost of hospitalizations was zero for the last-minute cluster, and was similar between the continuous cluster (€4,302 (2,066;9,0435)) and standard clusters (€4,071 (1,347;8,114)).
CONCLUSIONS: Costs between diagnosis and primary lung cancer treatment vary significantly across pathway clusters. Future work should elucidate the clinical and organisational drivers of these differences to refine care coordination
METHODS: Finite-mixture models were applied separately to local/locally-advanced (LLC) or advanced/metastatic (AMC) patients in the French Cancer cohort (FCC), an extract of the French healthcare claims database, using all reimbursed activity in the 12 months before lung cancer treatment (systemic or surgery) Resource use was categorised as inpatient stays, hospital-dispensed drugs, outpatient professional services, community-pharmacy drugs, medical transport and sick-leave indemnities. Median (Q1;Q3) cost per patient (€2023), was reported.
RESULTS: Four pre-treatment care-consumption trajectories were identified—early, late, continuous, and last-minute. Among LLC patients (n=6,964) we observed an early cluster (n=3,444, 49%) and a late cluster (n=2,617, 38%), distinguished by care escalation 6 versus ≤ 3 months before treatment; a continuous cluster with steady year-round use (n=378, 5%); and a last-minute cluster with minimal pre-cancer care (n=525, 8%). AMC patients (n=11,605) displayed analogous late (n=9,491, 82%), continuous (n=1,170, 10%) and last-minute (n=944, 8%) trajectories, with no early cluster detected. In LLC, median total cost was €3,913 (1,063;9,994) for the last-minute cluster, €5,788 (3,441;11,258) , €5,852 (2,906;12,580) for the two standard clusters, and €10,704 (6,043;19,551) for the continuously-followed cluster. Hospitalisation spend rose from €1,634 (469;5,37) to €3,469 (1,084;9,217).For AMC, the last-minute cluster averaged €1,506 (487;5,489), the standard cluster €8,807 (4,663;16,493), and the continuously-followed cluster €11,814 (6,793;20,214). The median cost of hospitalizations was zero for the last-minute cluster, and was similar between the continuous cluster (€4,302 (2,066;9,0435)) and standard clusters (€4,071 (1,347;8,114)).
CONCLUSIONS: Costs between diagnosis and primary lung cancer treatment vary significantly across pathway clusters. Future work should elucidate the clinical and organisational drivers of these differences to refine care coordination
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
SA24
Topic
Economic Evaluation, Study Approaches
Disease
Oncology