OBJECTIVES: Approximately 76.8% of the Brazilian population is assisted only by Public Health System (SUS). Severe resource limitations may impact the diagnosis, treatment, and clinical outcomes in this sector. Immuno-oncology is not available in SUS. Clinical and economic data in public scenario are scarce, particularly for Non-Small Cell Lung Cancer (NSCLC) stage III disease. This study assesses the unresectable NSCLC stage III patient’s evolution and expenditures in SUS.

METHODS: Information from patients with lung cancer (ICD C34) between January/2008 - December/2022 was evaluated using a public claims database (DATASUS). An epidemiological funnel and specific procedures were used to identify unresectable stage III NSCLC patients. Mortality, Outpatient, and Hospitalization Information databases were used to assess outcomes. Progression-free survival (PFS) was defined as the period between the end of chemoradiotherapy and death or changing the therapeutic regimen reported. Overall survival (OS) was defined as the period between the start of therapy and death. Hospitalization and outpatient costs were estimated according to database resources between January/2017 - December/2022 and evaluated in Brazilian Real (R$).

RESULTS: 5,924 unresectable stage III NSCLC patients receiving chemoradiation therapy were identified. Median OS was 15 months (IC 95% 14-15 months) and median PFS was 4 months (IC 95% 3-4 months). 2,701 deaths (45.6% of patients) were observed. There was a 21.3% increase in costs with disease management over the years (BRL 55.8 million and BRL 67.7 million for 2017 and 2022, respectively). The total cost for patients who progressed was 25.7% higher when compared to patients with non-progressive disease.

CONCLUSIONS: Stage III NSCLC patients treated in SUS have a poor prognosis, according to clinical outcomes calculated. The management of stage III NSCLC represents a high economic impact on the Brazilian government, especially with disease progression. Treatment alternatives that improve patients’ outcomes may also allow health managers to use resources more efficiently.