OBJECTIVES: To assess cost and healthcare resource use (HCRU) in patients with SCLC receiving second-line (2L) therapy to better understand economic burden of relapsed SCLC.

METHODS: EMBASE, MEDLINE, Cochrane databases (Jan,2011-Oct,2021) and Congress abstracts (2020-2021) were queried in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Population, Intervention & Comparators, Outcomes and Study Design (PICOS) criteria to identify cost and HCRU data in 2L SCLC.

RESULTS: Of the 2,042 studies identified, 4 studies fulfilled PICOS criteria: 3 retrospective database studies from the US (n=2) and Canada (n=1), and 1 cost analysis assessing cost of managing adverse events (AEs) and treatment administration with lurbinectedin and topotecan. In the US study using 2007-2013 SEER-Medicare data, SCLC patients (≥65y) incurred a mean per-patient-per-month (PPPM) cost of $8,942 with a mean total cost of $42,636 per patient, and an average 7.4 PPPM healthcare visits, of these the largest component was outpatient visits (6.9 PPPM). In another US study using 2005-2015 Indiana state cancer registry data, patients (≥18y) accumulated 3.5 PPPM healthcare visits during 2L treatment, most for outpatient visits (3.2 PPPM). The Canadian study using 2010-2018 electronic medical records and claim data reported an average of 1.27 hospitalizations and 13.01 hospitalization days per-patient-per-year (PPPY) in the first year after 2L treatment initiation, with 6.59 outpatient visits and 8.72 cancer physician visits PPPY. Lastly, the cost analysis showed the mean costs for AE management and drug administration in Spain were €3,042 and €11,358 for lurbinectedin and topotecan, respectively (£3,973 and £14,383 in UK). However, this analysis excluded trials permitting granulocyte-colony stimulating factor as primary prophylaxis.

CONCLUSIONS: The economic burden was substantial in patients with SCLC receiving 2L treatment. In addition, only 4 studies assessed cost/HCRU in these patients with relatively old data, indicating an evidence gap that warrants the need for further studies.