OBJECTIVES: Evidence concerning medical-care costs among advanced-staged NSCLC patients is lacking. The purpose of this analysis was to identify costs associated with first-line chemotherapy treatment and total lifetime medical-care costs among elderly Stage IIIB/IV NSCLC patients treated with commonly used two-drug chemotherapy (“doublet”) regimens. METHODS: Study patients included those aged 65 years and older who were diagnosed with Stage IIIB/IV NSCLC in a SEER cancer registry between 1997 and 2002 and who received first-line treatment with a commonly used doublet regimen. Study patients were followed in the SEER-Medicare database to evaluate costs while on first-line chemotherapy treatment as well as lifetime medical-care costs. Pairwise comparisons of costs estimated using non-parametric bootstrap methods were generated. RESULTS: Lifetime medical-care costs totaled approximately $70,000 among study patients, with almost half incurred while on first-line treatment. These costs were dominated by hospitalization and physician costs. Lifetime costs among patients treated with cisplatin or carboplatin and taxane (C/CT) were significantly higher than those for patients treated with cisplatin or carboplatin and gemcitabine (C/CG) (difference: $4781 [$1558-$8039]), and those for patients treated with other doublet therapy (difference: $5961 [$2333-$9614]). Comparing costs while on first-line therapy, costs among patients treated with C/CT were significantly higher than those among patients treated with C/CG ($5825 [$3872-$7770]), C/C and other ($5968 [$3995 - $7975]), or other doublet therapy ($3663 [$1620 - $5740]). CONCLUSION: Lifetime medical-care costs and costs while on first-line chemotherapy among treated Stage IIIB/IV NSCLC patients are substantial, with the highest costs among patients treated with doublet platinum and taxane regimens.