OBJECTIVES: To assess the incremental cost associated with the management of patients with primary non-squamous non-small cell lung cancer (NSCLC) with brain metastases (BM) at the time of diagnosis.

METHODS: A retrospective database analysis was performed using the French exhaustive Hospital medical information database (PMSI). Patients with metastatic lung cancer were identified through a combination of ICD-10 diagnosis codes: C34* for lung cancer combined with at least one metastasis code (C77*, C78*, C79*). All such patients hospitalised with metastatic lung cancer for the first time in 2013 were eligible. Patients with at least one prescription of bevacizumab or pemetrexed at the index hospitalisation or during the 24-month prospective following period were considered to have non-squamous NSCLC. Two cohorts were identified, one with brain metastases (N=971) and one with metastases at other sites (N=1,529). For each patient, total in-hospital medical resource consumption associated with the initial hospitalisation in 2013 and with any follow-up stays in the following 24 months was documented. Costs were attributed from official French national tariffs and expressed in 2017 Euros.

RESULTS: The mean number of hospitalisations in the 24-month follow-up period was 17 per patient with other metastases and 21 per patient with BM. >99% of patients in both groups received chemotherapy. 57.7% of patients with BM and 12.9% of patients with other metastases were managed by radiotherapy. 37.2% patients with BM and 23.5% patients with other metastases received palliative care. The associated cost was € 2,979 per patient-month for patients with BM and € 2,426 for patients with other metastases, representing a differential cost of € 553 per month. Radiotherapy (+€164/month) and palliative care (+€130/month) were the principal drivers of the incremental cost).

CONCLUSIONS: The presence of brain metastases at the time of diagnosis of non-squamous NSCLC carries a significant burden, and ways of lowering this burden are needed.