OBJECTIVES: To assess the real-world treatment patterns, healthcare costs (HCC), and healthcare resource utilization (HCRU) in patients with metastatic non-small cell lung cancer (NSCLC) having non-actionable mutations receiving second or subsequent line (2L+) systemic anti-cancer therapy (SACT).

METHODS: Adult patients with metastatic NSCLC having non-actionable mutation receiving SACTs on or after January 2020 until March2023 were identified from the US Marketscan® claims database. Patients were required to be continuously enrolled for 6 months before NSCLC diagnosis until ≥30 days after treatment and received no medications for small cell lung cancer.

Key outcomes included treatment patterns and per-patient per-month (PPPM) HCRU and HCC assessed over SACT treatment period.

RESULTS: A total of 2,815 patients received 2L+ treatment. At treatment initiation the median age was 64 years and 48% of the patients were enrolled in Medicare Advantage plans. The mean time from initial diagnosis to 2L+ treatment was 14.4 months and follow-up duration post 2L+ treatments was 10.5 months. The most frequently used treatments in 2L+ were immune checkpoint inhibitors (IO) (monotherapy or dual IO [40.6%]), followed by non-platinum–based chemotherapy monotherapy (14.2%). The average treatment duration was 4.2 months. Outpatient visits accounted for the majority of HCRU (mean [SD]: 5.2 [3.1] PPPM). Emergency department and inpatient utilization on average accounted for 0.12 [0.29] and 0.18 [0.4] visits PPPM.

Mean [SD] total HCC were $24,782 [$23,134] PPPM, the majority (80%) attributed to outpatient costs. Mean monthly costs were highest for patients receiving IO + Platinum based chemotherapy ($34,694) followed by docetaxel + ramucirumab ($30,848).

CONCLUSIONS: This analysis provides real-world insights on the treatment landscape for 2L+ metastatic NSCLC in the US. Despite increased treatment options, the 2L+ treatment of metastatic NSCLC with SACTs remains associated with a shorter treatment duration, high economic burden, suggesting significant remaining unmet needs for patients with metastatic NSCLC.