OBJECTIVES: In the last decade, new types of systemic therapy for first-line metastatic non-small cell lung cancer (mNSCLC) were approved in the US, including targeted therapy and immunotherapy. This research characterizes current trends in survival and cost of care for patients with mNSCLC defined by type of therapy.

METHODS: Surveillance, Epidemiology, and End Results data linked with Medicare claims were used to identify patients age ≥66 diagnosed with mNSCLC from 2017-2019 and followed through 2020. Median overall survival (mOS) and 48-month cumulative cost of care were estimated for patients who received targeted therapy, immunotherapy, and chemotherapy. Costs were inflated to 2022 US dollars using the medical component of the Consumer Price Index.

RESULTS: Among 7,306 patients with mNSCLC, 3,794 received first-line outpatient systemic therapy: 559 received targeted therapy (mean age 76.5 years, 35% male, 63% White, 91% with adenocarcinoma, and 41% in the highest socioeconomic status quintile); 1,323 received immunotherapy (mean age 75.2 years, 51% male, 86% White, 69% with adenocarcinoma, and 31% in the highest socioeconomic status quintile); and 1,912 received chemotherapy (mean age 74.2 years, 53% male, 86% White, 54% with adenocarcinoma, and 28% in the highest socioeconomic status quintile). Unadjusted mOS was longest for patients who received targeted therapy (23.5 months, 95% CI 20.5-32.9) compared to those who received immunotherapy (12.7 months, 95% CI 11.0-14.4) or chemotherapy (9.0 months, 95% CI 8.1-10.0). Cumulative 48-month total cost was highest for patients who received targeted therapy ($612,000) compared to those who received immunotherapy ($344,000) and chemotherapy ($313,000).

CONCLUSIONS: Patients who received targeted therapy or immunotherapy showed notably longer unadjusted survival than those who received chemotherapy. The higher total cost of care observed with targeted therapy may be related to the better prognoses for specific genetic mutations and to “treat-to-progression” dosing. Further adjusted analyses of differences are warranted.