OBJECTIVES: Metastatic non-small cell lung cancer (NSCLC) is a leading cause of cancer deaths. The objective of this study was to describe the real-world economic burden of mNSCLC in patients without an EGFR or ALK mutation.

METHODS: We conducted a retrospective observational cohort study using Optum Clinformatics US insurance claims. Patients were included if they had ≥ 2 claims for metastatic lung cancer between Nov-2016 and Jun-2021 and were excluded for etoposide treatment, EGFR/ALK therapies, other cancers, or clinical trial participation. Follow-up time was divided into 4 periods (Per1: diagnosis to treatment, Per2 first-line treatment, Per3: post-first-line treatment, Per4: last 60 days of life). Demographics, characteristics, resource use, and per-patient-per-month (PPPM) costs were assessed with descriptive statistics.

RESULTS: 8,234 patients were included. Median age was 71 (IQR: 65-77), 4,300 (52.2%) were male, and 6,659 (80.9%) were Medicare insured. Patients had a median Charlson comorbidity score of 7 (IQR: 6-8). Chemotherapy was used in 2,566 patients, Immunotherapy (IO) + chemotherapy in 2,479, IO in 2,692, and other treatments in 497. Per1 had a median duration of 1.1 months (IQR: 0.7-1.6) and mean PPPM costs of $34,937 (95% CI: 34,030-35,843) for Medicare and $64,253 (60,042-68,463) for commercial insurance. Per2 had a median duration of 3.7 months (1.8-6.4) and mean PPPM costs of $36,717 (35,658-37,777) for Medicare and $44,210 (42,255-46,164) for commercial insurance. Per3 had a median duration of 6.0 months (1.7-14.6) and mean PPPM costs of $16,938 (16,296-17,579) for Medicare and $23,512 (21,905-25,118) for commercial insurance. Per4 had a duration of 2.0 months and mean PPPM costs of $18,148 (17,528-18,768) for Medicare and $24,117 (22,205-26,030) for commercial insurance.

CONCLUSIONS: Metastatic NSCLC is associated with a substantial economic burden for the US healthcare system and patients. Earlier detection and new treatments may help to minimize the cost of managing NSCLC and further research is warranted.