OBJECTIVES: Treatment strategies for metastatic non-small cell lung cancer (mNSCLC) has undergone a transformation in the past decade due to the introduction of immunotherapy and targeted medications in first-line (1L) therapy. We present real-world data on clinical outcomes, direct health care resource utilization (HCRU) and cost in a 2.7-million-member health-provider in Israel.

METHODS: Newly diagnosed mNSCLC patients between Jan 2017-Dec 2020 were categorized by 1L treatment chemotherapy, targeted therapy or immunotherapy. HCRU and costs were calculated based on the Israeli Ministry of Health Prices and were assessed at a minimum of 6 months' follow-up (cutoff: 30th June 2021).

RESULTS: 886 patients included: 40.6% female, median age 68 years (IQR 61-74), 24.3% never smokers, 80.6% adenocarcinoma, 54% 0-1 performance status. Median follow-up was 27.12 months (95%CI:24.7-29.6). Median time on 1L was 2.3 months for chemotherapy (n=177), 12.3 months for targeted therapy (n=255) and 4.8 months for immunotherapy (n=463), and median overall survival was 9.09, 27.68 and 12.46 months, respectively. Total costs per-person-per-month (PPPM) in 1L were driven by radiotherapy for chemotherapy group, and medication for targeted therapy or immunotherapy groups. Overall costs for the 1L period, were higher for patients that received immunotherapy, and in the month before death, were higher for patients that received 1L targeted therapy. Total costs for the entire follow up period for patients who died were €121,155, €129,458, and €110,716 respectively.

CONCLUSIONS: High economic burden associated with treatment of mNSCLC exists, driven mainly by 1L therapy, which may reflect the greater use of targeted and immune therapies. Costs for inpatient services increased after cessation of 1L treatment and within the month before death. Further studies are required to assess the impact of immunotherapy and other innovative treatments on disease management costs of mNSCLC.