OBJECTIVES: To assess the real-world treatment patterns, healthcare costs, and healthcare resource utilization (HCRU) associated with second or later lines (2L+) of non-targeted systemic treatment for metastatic non-small cell lung cancer (NSCLC) among US adults.

METHODS: Adults (≥18 years) who received non-targeted systemic treatment for metastatic NSCLC on or after January 1, 2020 until March 31, 2023 were identified from the US Optum Clinformatics^® claims database. Patients were continuously enrolled for 6 months before NSCLC diagnosis until ≥30 days after receiving treatment.

Key outcomes included treatment patterns and per-patient per-month (PPPM) healthcare costs and HCRU, evaluated by lines of treatment and described for those receiving 2L+ treatment.

RESULTS: A total of 5,310 patients received 7,010 second or subsequent lines of treatment. The median age was 73 years at treatment initiation, 50% of patients were female, and 86% enrolled in Medicare Advantage. The median National Cancer Index adapted Charlson Comorbidity Index was 2.0. The mean follow-up duration was 8.7 months.

The most frequently used treatments in 2L+ were immune checkpoint inhibitors (ICI) without chemotherapy (CT) (43%), followed by ICI plus CT (18%). The average treatment duration was 4.0 months.

Outpatient visits accounted for the majority of HCRU (mean [SD]: 5.09 [5.84] PPPM). Emergency and inpatient utilization on average accounted for 0.10 (0.59) and 0.10 (0.52) visits PPPM respectively.

Mean (SD) total healthcare costs were $27,105 ($41,717) PPPM, the majority (87%) attributed to outpatient costs. Mean monthly costs were highest for patients receiving docetaxel + ramucirumab ($40,608), followed by ICI + platinum-based CT ($34,382).

CONCLUSIONS: This study provides most recent, real-world insights on the treatment landscape for 2L+ metastatic NSCLC.

Despite increased treatment options, the 2L+ treatment of metastatic NSCLC with non-targeted therapies remains associated with a high economic burden.

This suggests significant unmet needs may remain for management of metastatic NSCLC.