OBJECTIVES:: This study aims to describe real-world healthcare resource utilization (HCRU) and costs among advanced non-small cell lung cancer (NSCLC) patients without epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements who received chemotherapy or immunotherapy for second line of therapy (LOT) in Korea.

METHODS: This retrospective cohort study was conducted using the National Health Insurance Review and Assessment claims database from 2013 to 2020. We identified adult patients with refractory or relapsed stage Ⅲb–Ⅳ NSCLC after first LOT. Patients who have received EGFR or ALK tyrosine kinase inhibitors were excluded. HCRU and costs consisted of hospitalization, outpatient visits, and drug costs. HCRU and the costs were assessed during second LOT and calculated per patient per month (PPPM) for comparison within same treatment length. Costs were presented as US dollars (2021 USD; 1USD = 1,188.8 Korean Won).

RESULTS: Of 6,019 patients included, 1,124 (18.7%), 3,107 (51.6%) and 1,788 (29.7%) received docetaxel, other chemotherapies and immunotherapy for second LOT, respectively. Mean number of HCRU for docetaxel, other chemotherapies, and immunotherapy group was 1.2, 1.2, and 0.8 PPPM for hospitalization; 2.8, 3.5, and 2.5 PPPM for outpatient visits, respectively. Mean total costs PPPM for docetaxel group were $4,400 ($3,707 hospitalization; $693 outpatient visits); for other chemotherapies group, $4,173 ($3,251 hospitalization; $922 outpatient visits); for immunotherapy group, $8,635 ($5,121 hospitalization; $3,514 outpatient visits). Mean costs for drugs were $1,278, $1,244 and $5,453 PPPM for docetaxel, other chemotherapies and immunotherapy groups, respectively. More than 90% of total drug costs were in-hospital drug costs.

CONCLUSIONS: Costs associated with hospitalization and in-hospital drug were the majority of total and drug costs, respectively. This national-level study quantifies the economic burden of stage Ⅲb–Ⅳ NSCLC without EGFR mutations or ALK rearrangements in Korea.