ECONOMIC BURDEN, HEALTHCARE RESOURCE UTILIZATION (HCRU), AND HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN PREVIOUSLY TREATED, NON-SQUAMOUS NON-SMALL CELL LUNG CANCER (NSQ-NSCLC): A SERIES OF SYSTEMATIC LITERATURE REVIEWS (SLRS)
Author(s)
Sanjana Chandrasekar, MPH1, Tracy Taylor, Masters2, Joanna Campbell, PhD3, Priccila Zuchinali, Graduate4, Daniela Myers, MPH5, Ling-I Hsu, PhD6, Peter Hur, Graduate7, Joseph C. Cappelleri, MPH, MS, PhD8, Haitao Chu, PhD, MD9.
1HTA Value and Evidence, Pfizer, New York, NY, USA, 2Thermo Fisher Scientific, Amsterdam, Netherlands, 3Evidera, London, United Kingdom, 4Thermo Fisher, Ottawa, ON, Canada, 5Pfizer Inc, Philadelphia, PA, USA, 6Pfizer, San Francisco, CA, USA, 7Pfizer, New York, NY, USA, 8Pfizer, Newington, CT, USA, 9Pfizer, Edina, MN, USA.
1HTA Value and Evidence, Pfizer, New York, NY, USA, 2Thermo Fisher Scientific, Amsterdam, Netherlands, 3Evidera, London, United Kingdom, 4Thermo Fisher, Ottawa, ON, Canada, 5Pfizer Inc, Philadelphia, PA, USA, 6Pfizer, San Francisco, CA, USA, 7Pfizer, New York, NY, USA, 8Pfizer, Newington, CT, USA, 9Pfizer, Edina, MN, USA.
OBJECTIVES: Patients with locally advanced, unresectable, or metastatic NSQ-NSCLC who progress after first-line therapy have limited treatment options and ongoing disease burden. This SLR series aimed to characterize direct and indirect costs, HCRU, and HRQoL outcomes in this setting.
METHODS: The SLRs were conducted in accordance with PRISMA guidelines. MEDLINE, Embase, PsychINFO, EconLit and EBM reviews were searched via Ovid from inception to December 10, 2025, alongside grey literature sources. Evidence on economic burden, HCRU, and utilities was primarily derived from real-world and observational studies, while HRQoL outcomes were assessed using RCTs and real-world studies.
RESULTS: Across the three SLRs, 3,540 articles were screened and 20 articles were included. One study across seven European countries reported mean total direct costs of €26,477 per patient over a mean follow-up of 1.7 years, of which €1,107 were hospitalizations (2018 values). Hospitalization was the most frequently reported HCRU outcome, identified across five studies from North America, Asia and Europe. Among European studies, the proportion of hospitalized patients ranged from 17.5% to 73.3%. Eight RCTs reported patient-reported symptom burden, including dyspnea, cough, and pain. Five RCTs reported targeted and immunotherapy-based treatments delayed deterioration in HRQoL and lung cancer-related symptoms compared with chemotherapy-based comparators (predominantly docetaxel); three reported statistically significant delays. Utility values from four studies in global, European, Taiwanese and Thai populations were derived using EQ-5D-3L/5L instruments and scores ranged from 0.49 to 0.94. Lower utilities were reported for progressing versus progression-free disease (0.49 vs 0.87) and second versus third line (0.7 vs 0.8).
CONCLUSIONS: Patients treated in the second line or later for NSQ-NSCLC are associated with substantial economic burden and impaired HRQoL, with disease progression linked to persistent symptom burden and declining health status. These findings underscore the need for additional utility evidence to better inform future economic evaluations.
METHODS: The SLRs were conducted in accordance with PRISMA guidelines. MEDLINE, Embase, PsychINFO, EconLit and EBM reviews were searched via Ovid from inception to December 10, 2025, alongside grey literature sources. Evidence on economic burden, HCRU, and utilities was primarily derived from real-world and observational studies, while HRQoL outcomes were assessed using RCTs and real-world studies.
RESULTS: Across the three SLRs, 3,540 articles were screened and 20 articles were included. One study across seven European countries reported mean total direct costs of €26,477 per patient over a mean follow-up of 1.7 years, of which €1,107 were hospitalizations (2018 values). Hospitalization was the most frequently reported HCRU outcome, identified across five studies from North America, Asia and Europe. Among European studies, the proportion of hospitalized patients ranged from 17.5% to 73.3%. Eight RCTs reported patient-reported symptom burden, including dyspnea, cough, and pain. Five RCTs reported targeted and immunotherapy-based treatments delayed deterioration in HRQoL and lung cancer-related symptoms compared with chemotherapy-based comparators (predominantly docetaxel); three reported statistically significant delays. Utility values from four studies in global, European, Taiwanese and Thai populations were derived using EQ-5D-3L/5L instruments and scores ranged from 0.49 to 0.94. Lower utilities were reported for progressing versus progression-free disease (0.49 vs 0.87) and second versus third line (0.7 vs 0.8).
CONCLUSIONS: Patients treated in the second line or later for NSQ-NSCLC are associated with substantial economic burden and impaired HRQoL, with disease progression linked to persistent symptom burden and declining health status. These findings underscore the need for additional utility evidence to better inform future economic evaluations.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE702
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Patient-Centered Research
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology