OBJECTIVES: NSCLC, the most dominant form of lung cancer, accounts for 80–85% of all cases. USA national estimates suggest it to be the fifth-costliest tumor. This SLR aimed to identify economic evidence, including economic evaluations, health state utility values (HSUV), and cost and resource use (CRU) data for patients with advanced, metastatic, or recurrent NSCLC who progressed on any prior NSCLC treatment.

METHODS: MEDLINE, Embase, The International Health Technology Assessment Database and NHS Economic Evaluation Database were searched in June 2023, and supplemented with grey literature hand-searches. Quality of extracted publications was assessed using the Drummond checklist. Due to the volume of records, prioritization was undertaken according to assessed NSCLC population, geography of data collection, publication date and outcomes reported.

RESULTS: Of the 104,174 records retrieved, 42 unique studies were prioritized, reporting on economic evaluations (n=23), HSUV (n=10) and CRU data (n=16). Multiple studies (n=18) reported varying incremental cost-effective ratios (ICERs) comparative to docetaxel. A Japanese study found the incremental cost/quality adjusted life years (QALY) of nab-paclitaxel compared to docetaxel was JPY 19,694,424, whilst a UK study reported £35,657/QALY comparing nivolumab to docetaxel. Improved quality of life compared to docetaxel was reported for pembrolizumab (n=1; HSUV: 0.687–0.761) and nivolumab (n=1; difference in mean change in utility index scores: 0.027). Reported overall treatments cost varied across studies, from €2,671 (annual cost per patient, second-line [2L] treatment for non-squamous NSCLC without immunotherapy) to £67,283 (total mean costs during on-treatment with atezolizumab). Mean length of hospital stay (n=6) ranged from 0.7–36 days.

CONCLUSIONS: Overall economic burden of treating NSCLC is high, particularly for patients who progress onto 2L+ regimens, due to the high cost of healthcare resources and therapeutic options. There is a need for novel therapies that extend survival, reducing progression-related hospitalizations and additional treatment regimens.