DOES AREA DEPRIVATION EXPLAIN GEOGRAPHIC VARIATION IN ACCESS TO ADVANCED THERAPIES FOR STAGE IV NON-SMALL CELL LUNG CANCER IN ENGLAND?
Author(s)
Ayaka Saito, MD, MSc1, Bernard Rachet, PhD2, John Cairns, MA,Mphil2.
1PhD Student, London School of Hygiene & Tropical Medicine, London, United Kingdom, 2London School of Hygiene & Tropical Medicine, London, United Kingdom.
1PhD Student, London School of Hygiene & Tropical Medicine, London, United Kingdom, 2London School of Hygiene & Tropical Medicine, London, United Kingdom.
OBJECTIVES: To estimate how much of the geographic variation in access to immune checkpoint inhibitors (ICIs) and EGFR tyrosine kinase inhibitors (EGFR-TKIs) for non-small cell lung cancer (NSCLC) in England is explained by area deprivation, and whether this differs between the two therapy classes.
METHODS: We identified adults with stage IV NSCLC in England (2015-2022) from linked cancer registry and Systemic Anti-Cancer Therapy data. Outcomes were receipt of any systemic therapy (entry to treatment) and, among treated patients, first-line ICI or EGFR-TKI (treatment selection). Multilevel logistic models nesting patients within 20 Cancer Alliances (regional networks) and 187 treating NHS Trusts (individual providers) estimated between-area variation (median odds ratio [MOR]). Deprivation's contribution was assessed by proportional change in variance (PCV) after adding area deprivation quintiles, adjusting for age, sex and ethnicity; relative indices of inequality (RII) summarised gradients.
RESULTS: Among 138,252 patients, 34,314 (24.8%) received systemic therapy. After case-mix adjustment, systemic therapy receipt varied across Cancer Alliances (MOR 1.17) with a strong deprivation gradient (RII 1.69), but geographic variation was not explained by deprivation (PCV -11.5%). ICI receipt varied across Cancer Alliances (MOR 1.32) but its variation was greater at the Trust level (MOR 1.45), with no reduction after deprivation adjustment (PCV -1.3%) and no deprivation gradient (RII 0.96). By contrast, EGFR-TKI receipt showed smaller Alliance-level variation (MOR 1.19), of which deprivation explained 39%, with a strong deprivation gradient (RII 2.49). Findings were robust in patients with performance status 0-1.
CONCLUSIONS: Geographic variation in access to systemic therapy and ICIs was present but not explained by deprivation. ICI variation was greater at the treating-Trust than the Alliance level, indicating provider- and system-level drivers. By contrast, variation in EGFR-TKI receipt was partly explained by deprivation. This may reflect ethnic and smoking-related EGFR mutation distribution; biomarker-informed analyses are needed to distinguish access-driven from biology-driven inequality.
METHODS: We identified adults with stage IV NSCLC in England (2015-2022) from linked cancer registry and Systemic Anti-Cancer Therapy data. Outcomes were receipt of any systemic therapy (entry to treatment) and, among treated patients, first-line ICI or EGFR-TKI (treatment selection). Multilevel logistic models nesting patients within 20 Cancer Alliances (regional networks) and 187 treating NHS Trusts (individual providers) estimated between-area variation (median odds ratio [MOR]). Deprivation's contribution was assessed by proportional change in variance (PCV) after adding area deprivation quintiles, adjusting for age, sex and ethnicity; relative indices of inequality (RII) summarised gradients.
RESULTS: Among 138,252 patients, 34,314 (24.8%) received systemic therapy. After case-mix adjustment, systemic therapy receipt varied across Cancer Alliances (MOR 1.17) with a strong deprivation gradient (RII 1.69), but geographic variation was not explained by deprivation (PCV -11.5%). ICI receipt varied across Cancer Alliances (MOR 1.32) but its variation was greater at the Trust level (MOR 1.45), with no reduction after deprivation adjustment (PCV -1.3%) and no deprivation gradient (RII 0.96). By contrast, EGFR-TKI receipt showed smaller Alliance-level variation (MOR 1.19), of which deprivation explained 39%, with a strong deprivation gradient (RII 2.49). Findings were robust in patients with performance status 0-1.
CONCLUSIONS: Geographic variation in access to systemic therapy and ICIs was present but not explained by deprivation. ICI variation was greater at the treating-Trust than the Alliance level, indicating provider- and system-level drivers. By contrast, variation in EGFR-TKI receipt was partly explained by deprivation. This may reflect ethnic and smoking-related EGFR mutation distribution; biomarker-informed analyses are needed to distinguish access-driven from biology-driven inequality.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD111
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care
Disease
Biologics & Biosimilars, Oncology, Personalized & Precision Medicine, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)