OBJECTIVES

To assess total direct medical cost (TC) among adult patients starting systemic therapy (ST) pre- and post-approval of programmed cell death/programmed death-ligand 1 inhibitors (PD(L)-1) for aNSCLC (pre-/post-IO).

METHODS

MORE Registry® claims data were utilized to identify adult patients diagnosed with lung cancer (ICD-9 162.X, ICD-10 C34.X) initiating first-line (1L) ST within 6 months of diagnosis from March 2013-March 2014 (pre-IO) or March 2015-December 2016 (post-IO). Patients with SCLC, secondary malignancies, <1 month follow-up and on clinical trials were excluded. Wholesale Acquisition Cost, Average Sales Price, Medicare Physician Fee Schedule and Hospital Outpatient Payment System were used for drug and procedure costs. Data were analyzed using descriptive statistics. Six and 12-month sensitivity analyses were performed.

RESULTS

Of 5741 treated aNSCLC patients, 2997 (52%) were in the post-IO cohort. By cohort (pre- vs. post-), mean age was 64.5 vs. 66.1 years, Charlson Comorbidity Index: 2.2 vs. 2.4, treatment lines per patient: 1.9 vs. 1.4, follow-up time: 16.9 vs. 8.9 months, received 2L: 52% vs. 30%, received 3L+: 20% vs. 8%. Mean TC was $165,548 vs. $95,715, TC per patient per month (PPPM) $11,522 vs. $11,977, p=0.060.

Mean 6-month TC was $80,912 vs. $71,286 (PPPM $13,114 vs. $11,636), p<0.0001. Mean 12-month TC was $121,672 vs. $118,215 (PPPM $10,139 vs. 9,851), p=0.473. Outpatient costs by cohort represented 70% vs. 77% of TC (including ST costs 19% vs. 22%); hospitalizations: 11% vs. 8%, and emergency department (ED) visits: 19% vs. 15%. Mean PPPM in 1L was $12,028 vs. $12,123, in 2L: $13,561 vs. $14,488, in 3L+: $14,670 vs. $15,616.

CONCLUSIONS

Early data show lower costs of ED visits and hospitalizations in the post-IO era, positively impacting cost of care. Mean 6- and 12-month TC also favored the post-IO period. These data challenge concerns that innovative therapeutics will drive up TC in aNSCLC.