OBJECTIVES

Exon 20 insertions (e20i) are genetic mutations included in the tyrosine kinase (TK) domain of the epidermal growth factor receptor (EGFR), accounting for 4% to 10% of Non-small Cell Lung Cancer (NSCLC) with EGFR mutations. E20i NSCLC patients are resistant to currently approved EGFR-TK inhibitors and have worse prognosis. This study is aimed at providing a quantitative assessment of the economic burden and Quality of Life (QOL) for e20i NSCLC patients in China.

METHODS

A quantitative survey was developed to collect patients’ demographic and socioeconomic information, diagnosis and treatment history, and direct and indirect costs. Patients had to meet the following inclusion criteria: 1. They had to have a confirmed e20i NSCLC diagnosis, 2. Their condition progressed after first-line treatments, and 3. They had not participated in any clinical trials. EQ-5D-5L instrument was also administered to measure QOL. Patient medical records were used to verify treatments and cost information. A descriptive analysis was performed to the survey data. Both the utility score and VAS score from the EQ-5D-5L were calculated and reported.

RESULTS

A total of 28 patients (11 male and 17 female) from diverse geographic locations were recruited into the study. The average age was 59. 43% of the patients experienced moderate to severe depression after being diagnosed with e20i NSCLC. The average utility score was 0.83 (SD=0.20) and the average VAS score was 73.71(SD=17.11). The total out-of-pocket direct medical costs for patients receiving three lines of treatments were CNY260,874 (SD=CNY97,094), 8.1 times the national personal disposable income in 2020. The indirect cost per month for IL and 2L were CNY4,623 (SD=CNY3,447) and CNY5,153(SD=CNY3,670), respectively.

CONCLUSIONS

E20i NSCLC is a severe disease leading to both psychological stress and reduced QOL. E20i NSCLC treatments also create significant financial burden for the patients even under the coverage of national health insurance.