OBJECTIVES

: The introduction of novel immunotherapies has changed the clinical management of non-small cell lung cancer (NSCLC), the leading cause of cancer death in the U.S. We examined trends in treatment patterns, survival, and spending following the introduction of these therapies to understand their population-level impacts in the U.S.

METHODS

: We identified 25841 patients aged >65 years diagnosed with stage IIIB-IV NSCLC in 2012-2015 using the SEER-Medicare data. We estimated the percentage of patients who received any antineoplastic therapy, including immune checkpoint inhibitors, and examined the trends in overall survival and Medicare spending within two years of diagnosis using Medicare claims until 2016 and survival data until 2017. To determine whether the trends were attributable to the availability of new treatment options, we classified patients into quintiles of predicted probability of receiving antineoplastic therapy and compared trends across quintiles.

RESULTS

: The percentage of patients treated with any antineoplastic therapy remained the same at 46.7% in 2012 and 2015, whereas the use of immune checkpoint inhibitors increased from 0% to 15.2%. The two-year survival probability and mean two-year outpatient spending per patient increased by 3.3% (95% CI: 2.0, 4.5) and $7661 (CI: 5902, 9311), respectively. Among patients in the highest quintile, the two-year survival probability and mean two-year outpatient spending increased by 6.2% (CI: 2.1, 10.2) and $11437 (CI: 7964, 18066), respectively. Changes in two-year survival probability were not statistically significant for patients in the lowest quintile (difference: 2.6% (CI: -0.1, 4.4); the mean two-year outpatient spending increased by $3286 (CI: 1525, 5940) in this group.

CONCLUSIONS

: Rapid adoption of immune checkpoint inhibitors was accompanied by improvements in overall survival and considerable increases in Medicare spending in the U.S. As these therapies continue to change clinical oncology practice, further efforts are needed to ensure their effective and efficient use, and to understand their population-level impacts.