Disparities in Health Outcomes and Care Among ALK-Positive Non-Small Cell Lung Cancer Patients: Real-World Evidence of Social Determinants of Health
Author(s)
Rahul Mudumba, MS, Xiaofan Liu, MPH, Drishti Baid, BA, Jorge J Nieva, MD.
University of Southern California, Los Angeles, CA, USA.
University of Southern California, Los Angeles, CA, USA.
OBJECTIVES: This retrospective observational cohort study examines disparities in clinical outcomes and healthcare costs among patients with advanced anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) receiving first-line ALK tyrosine kinase inhibitors (TKIs) in the United States.
METHODS: Data from Optum’s de-identified Clinformatics® Data Mart Database (2016-2021) were utilized. Patients were identified using ICD-10 codes for lung cancer and ALK TKI pharmacy claims. Eligible patients were ≥18 years of age, with ≥6 months of continuous enrollment prior to the index date and at least one ALK TKI prescription fill. Pharmacy, inpatient, outpatient, professional service, and ancillary costs (2024 US dollars) were measured on a per-patient-per-month (PPPM) basis. A generalized linear model with a gamma distribution and log-link function examined factors influencing costs. Time-to-treatment discontinuation or death (TTD) and overall survival (OS) were assessed using the Kaplan-Meier method, with a Cox proportional hazards model used to assess associations between social determinants and survival outcomes, adjusted for sociodemographic and clinical characteristics.
RESULTS: Among 696 patients, mean age was 64.2 years (SD: 13.7), 54.4% were female, 49.4% enrolled in Medicare Advantage, and the cohort was 68.5% non-Hispanic white, 12.8% Black, 10.0% Hispanic, and 8.6% Asian. Median OS and TTD were 25.5 months (95% CI: 21.1-32.5) and 8.0 months (95% CI: 6.4-9.6), respectively, with PPPM costs of $28,216 (95% CI: $26,056-$30,375). While OS and TTD did not significantly differ by race, Hispanic patients incurred higher monthly healthcare costs (+$7,117; 95% CI: $121-$14,113) compared to non-Hispanic white patients. This disparity was driven primarily by professional service utilization (+$2,636/month; 95% CI: $849-$4,422), including physician visits, imaging, and lab tests.
CONCLUSIONS: Despite similar clinical outcomes, Hispanic ALK+ NSCLC patients experienced higher healthcare utilization, particularly in professional services. Further research is needed to understand drivers of higher utilization which may not improve clinical outcomes.
METHODS: Data from Optum’s de-identified Clinformatics® Data Mart Database (2016-2021) were utilized. Patients were identified using ICD-10 codes for lung cancer and ALK TKI pharmacy claims. Eligible patients were ≥18 years of age, with ≥6 months of continuous enrollment prior to the index date and at least one ALK TKI prescription fill. Pharmacy, inpatient, outpatient, professional service, and ancillary costs (2024 US dollars) were measured on a per-patient-per-month (PPPM) basis. A generalized linear model with a gamma distribution and log-link function examined factors influencing costs. Time-to-treatment discontinuation or death (TTD) and overall survival (OS) were assessed using the Kaplan-Meier method, with a Cox proportional hazards model used to assess associations between social determinants and survival outcomes, adjusted for sociodemographic and clinical characteristics.
RESULTS: Among 696 patients, mean age was 64.2 years (SD: 13.7), 54.4% were female, 49.4% enrolled in Medicare Advantage, and the cohort was 68.5% non-Hispanic white, 12.8% Black, 10.0% Hispanic, and 8.6% Asian. Median OS and TTD were 25.5 months (95% CI: 21.1-32.5) and 8.0 months (95% CI: 6.4-9.6), respectively, with PPPM costs of $28,216 (95% CI: $26,056-$30,375). While OS and TTD did not significantly differ by race, Hispanic patients incurred higher monthly healthcare costs (+$7,117; 95% CI: $121-$14,113) compared to non-Hispanic white patients. This disparity was driven primarily by professional service utilization (+$2,636/month; 95% CI: $849-$4,422), including physician visits, imaging, and lab tests.
CONCLUSIONS: Despite similar clinical outcomes, Hispanic ALK+ NSCLC patients experienced higher healthcare utilization, particularly in professional services. Further research is needed to understand drivers of higher utilization which may not improve clinical outcomes.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD116
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology