OBJECTIVES:

Few studies explore healthcare resource utilization (HCRU) and their associated costs during the full course of disease. In advanced cancers, HCRU and costs usually increase until end of life. The objective was to describe the evolution of HCRU and costs over 4 years of patients with advanced non-small cell lung cancer (aNSCLC) initiating nivolumab in ≥2^nd line.

METHODS:

Based on the French hospitals reimbursement database, all aNSCLC patients initiating nivolumab in 2^nd line or later in 2015 or 2016 were followed until 2019. HCRU (including hospitalizations and hospital visits) and costs (payor perspective) were described annually after nivolumab initiation and adjusted for the 4^th year using percentage difference between 2-years extraction. Trends in HCRU were analyzed with the Mann-Kendall test. As most patients did not reach a 4-years follow-up, cost-analysis was performed with 3 methods for censored cost data: 1) without adjustment on all patients, 2) without adjustment in uncensored cases only and 3) with the Bang&Tsiatis method on all patients.

RESULTS:

10,452 patients initiated nivolumab in 2015-16. The mean number of hospital visits per patient diminished over time (p<0.001): 23.3 Year 1 (Y1; n=10,452), 21.3 Year 2 (Y2; n=4645), 19.7 Year 3 (Y3; n=2640), 13.2 Year 4 without adjustment and 18.3 with adjustment (Y4, n=1630). Overall hospitalization duration per patient (days) decreased over time (p<0.001): 36.0 (Y1), 29.4 (Y2), 25.2 (Y3) and 14.9 (Y4-unadjusted) and 20.5 (Y4-adjusted). Whatever the adjustment method, annual cost per patient tended to decrease. The method without adjustment provided the lowest cost over time (€44,404 (Y1), €32,206 (Y2); €28,552 (Y3); €18,841(Y4)) while the Bang&Tsiatis method presented the highest (€45,002 (Y1), €36,330 (Y2); €35,080 (Y3); €28,931 (Y4)).

CONCLUSIONS:

HCRU and costs of NSCLC patients treated by nivolumab decreased over time. This study allowed exploration of the uncertainty in the estimation of HCRU and costs due to censored follow-up data.