OBJECTIVES: To systematically identify and understand the healthcare cost and resource utilization (HCRU), health-related quality of life (HRQoL), and utilities for 1L MT Tx in patients with stage IIIB-IV aNSCLC and no known driver mutation.

METHODS: EconLit, EMBASE, and MEDLINE databases were searched from January 2015 to February 2021. Additionally, desk research was conducted for conference abstracts.

RESULTS: Among 22 publications identified, 10 were cost-effectiveness (CE) analyses (US: 5, China: 3, US&UK: 1, France: 1) and 12 HRQoL studies. No HCRU or utility data were found outside CE studies. 1L MT Tx consisted of necitumumab, pemetrexed, pembrolizumab, bevacizumab, gemcitabine, and docetaxel. Major cost drivers were drug acquisition costs ranging from €932.94 per unit (bevacizumab [France]) to $9,797 per month (pembrolizumab [US]). Costs for administration ranged from $143.24 (necitumumab per cycle [US]) to $3,854 (pembrolizumab [US]) and €357.27 to €788.54 for a 3-week cycle (pemetrexed/bevacizumab or gemcitabine [France]). Hospitalization costs varied from €2,288/day in France to $2,500/day in the US and costing up to $24,164 for hospitalization due to neutropenia (US). Other observed adverse event (AE)-related hospitalization costs were for pneumonitis: $8,766.53, thrombocytopenia: $5,308.86, and anemia: $7,969.56. Cost year ranged from 2014-2018. Median hospital stay ranged from 6.5-8 days for 1L MT compared to 11 days for 1L induction. No maintenance-specific utility values were identified. HRQoL was similar to induction (n=8). One study reported significantly worse EORTC QLQ-Core 30 and EORTC QLQ-Lung Cancer 13 QoL subdomain scores and global score after sunitinib maintenance versus placebo.

CONCLUSIONS: Contemporary HCRU, HRQoL, and utility data are limited in the 1L MT aNSCLC setting. Further research is needed to evaluate HCRU and HRQoL that reflect the rapidly evolving Tx landscape, critical for subsequent development of robust economic models.