Objectives: Examine treatment patterns and costs associated with small cell lung cancer (SCLC) in Medicare patients.

Methods: A retrospective analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data. Patients were included if they had a record with a diagnosis of SCLC in the database from 1/1/2007 – 12/31/2017 and were ≥65 years of age at diagnosis. Patients also had continuous enrollment for ≥180 days pre-SCLC diagnosis. Costs are 2017USD.

Results: 13,516 patients met criteria; 57.7% were female, mean age was 74 years, and 89.5% were white. The majority (73.1%) were diagnosed at stage 4. Mean time from diagnosis to first line (1L) treatment was 6 weeks, and 55.4% of patients initiated 1L. Of these, 36.7% went on to second line (2L). Carboplatin + etoposide and cisplatin + etoposide were by far the most common 1L regimens (67.3% and 24% of patients, respectively). In 2L, 44.7% of patients received monotherapy, with topotecan being the most common (28.4%). Carboplatin + etoposide was used for approximately 20% of 2L patients. Median total healthcare costs in 1L were $28,578 among platinum-based chemotherapy regimen users, with median anticancer regimens accounting for 33.4% ($9,547) of 1L costs among patients with at least 30 days of follow-up post diagnosis (N=5,498). Median total healthcare costs in 2L were $20,592 among chemo-monotherapy users, with median anticancer regimens accounting for 52.3% ($10,771) of 2L costs among patients with at least 30 days of follow-up post diagnosis (N=700).

Conclusions: Less than 60% of SCLC patients receive any anticancer therapy, and fewer still receive more than one line of treatment, highlighting the ongoing need for effective therapies for SCLC. Median total 1L and 2L healthcare costs for patients using platinum-based chemotherapy regimens were $28,578 and $20,592, respectively; inpatient and anticancer therapies accounted for the majority of healthcare costs.