OBJECTIVES: Neutropenia is a driver of infection-related mortality in Non-Small Cell Lung Cancer (NSCLC) patients with chemotherapy-induced myelosuppression. Prior research found incident neutropenia in 24% of advanced NSCLC Medicare patients during first-line chemotherapy. Neutropenia-related care comprised up to one-third of total patient cost.

We first confirmed the real-world incidence of cytopenia in an NSCLC population. Then we estimated the subsequent hospitalizations and total cost of care using OncoHealth Real-World Data (RWD). Our objective was to temporally sequence cytopenia diagnosis, hospitalization and accrual of costs to identify a window for targeting symptom management and patient engagement.

METHODS: A retrospective observational study for incident cytopenia including anemia, neutropenia, leukopenia, and thrombocytopenia among 10,767 NSCLC patients initiating treatment from 2016–2022. OncoHealth RWD includes prior authorization intake, payer claims, and unstructured data derived from clinical documentation. Cytopenia was confirmed using claims, lab values and observations within 30 days of initial diagnosis. We describe rates of cytopenia diagnosis, hospitalization and post-diagnosis total cost of care after 8 weeks of follow-up.

RESULTS: Cohort members had a mean age of 72 years, 50% female, 57% Caucasian, and 55% Medicare. We observed a mean total cost of $159,959 ($528,300 SD, n=2,334) for all cytopenia patients. 273 patients were hospitalized within one month of index cytopenia with a mean total cost of $298,819 ($1,118,588 SD), compared to mean $121,690 ($137,893 SD) for 152 patients with no hospitalization following their cytopenia diagnosis. Compared to those hospitalized within 1 month of cytopenia diagnosis, the 80 patients who were hospitalized between 1 to 2 months after cytopenia experienced a mean cost of $88,069 ($81,412 SD).

CONCLUSIONS: The OncoHealth RWD reveals a cost spike following cytopenia diagnosis and hospitalization within the following month. These data offer a basis for cost/benefit modeling to further assess associated risks and symptom management opportunities.