OBJECTIVES: The introduction of nivolumab and pembrolizumab has radically changed the treatment landscape in patients with Non-small Cell Lung Cancer (NSCLC). The study objective is to compare the first-year costs of care associated with NSCLC for the historical (2011-2015) and novel (2016-2017) treatment eras among Medicare beneficiaries. The historical and novel treatment era was defined as the pre and post-approval of nivolumab and pembrolizumab.

METHODS: The first-year NSCLC-attributable costs and out-of-pocket (OOP) costs at diagnosis were estimated by a case-control approach using 2011 to 2017 Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The NSCLC costs for ≥ 65 years was based on the national SEER incidence registries, which account for 26.5% of the U.S. population. The cost was estimated by combining all the claims files (inpatient, outpatient, carrier, durable medical equipment, home health care, and hospice) for a patient. Costs were adjusted to 2021 US dollar.

RESULTS: A total of 98,377 patients were diagnosed with NSCLC with 50.3% females, 78.6% white, and 49.7% patients diagnosed at stage IV. With the exception of stage III, which had the highest associated costs in 2011-2014, the mean first-year per-patient cancer-attributable costs increased with stage for all years. Mean per-patient cancer-attributable costs increased in the novel treatment era for stage IV by 3.6% from $51,189 to $53,056. In the novel treatment era, cancer-attributable costs accounted for 69.1%, 82.4%, 86.3% and 92.5% of total healthcare costs in stages I-IV respectively. Per-patient OOP costs decreased by 26.0%, 15.8%, and 0.3% for stages I-III respectively, and increased by 1.8% for stage IV between 2011 and 2017. The national cancer-attributable costs increased from $1.24 billion to $1.26 billion between 2011 and 2017, with the highest increment observed in stage IV patients.

CONCLUSIONS: Per-patients NSCLC-attributable costs increased significantly among stage IV patients in the novel treatment era highlighting the need for earlier diagnosis.