OBJECTIVES:

Advanced (stage IIIb/IV) non-small cell lung cancer (aNSCLC) has a significant economic impact on society. This 7-country European study describes predictors of real-world per-patient costs [systemic treatment and health care resource utilization (HRCU)] of patients with aNSCLC who received at least 2 lines of systemic treatment (2L+).

METHODS:

The LENS (Leading the Evaluation of non-squamous and squamous NSCLC) retrospective chart review was a 7-country study conducted in 2 waves: W1 included France, Germany, Italy, Spain, and W2 included England, the Netherlands, Sweden. Within LENS, patients with aNSCLC diagnosis who initiated 2L were sampled from oncology/pulmonology practices, and followed from diagnosis (W1: 07/2009-08/2011; W2: 07/2010-09/2012) through most recent visit/death. Weighted average of country-specific unit costs (2016 Euro) was applied to systemic anticancer therapy usage and HCRU (hospital/ER visits, surgeries, radiotherapy, ancillary care, biomarker testing) to determine total cost from aNSCLC diagnosis to death. Generalized linear models (gamma distribution, log link) were used to assess clinical and demographic predictors associated with higher total costs.

RESULTS:

Of 973 2L+ patients with median overall survival (OS) of 19.8 months from advanced diagnosis (range 3.1-68.7 months; median OS squamous: 18.8, non-squamous: 21.4), 79.0% were followed through death. Weighted median total per-patient costs were €10,991 [ranges: €7,197 (Germany) to €27,381 (Sweden); €7,183 (squamous) to €18,340 (non-squamous)]. Drug costs were 67.5% of total costs. Statistically significant (p<0.05) predictors for higher total lifetime HCRU costs were non-squamous histology and private insurance status. Positive EGFR mutation status predicted significantly lower costs.

CONCLUSIONS:

Drug costs were the primary cost driver in this pre-immunotherapy era real-world study, although this may partially be due to the 2L+ study population. Within this cohort, histology, EGFR mutation and insurance status were significant predictors for total treatment and HRCU costs, whereas characteristics such as age, gender, smoking history, ECOG PS, and IASLC disease stage were not significant.