Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy

a real-world observational study

Karen E. Skinner, Ancilla W. Fernandes, Mark S. Walker, Melissa Pavilack, Vanderwalde Ari

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Aims: To assess healthcare costs during treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and following disease progression in patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective analysis of medical records of US community oncology practices was conducted. Eligible patients had advanced NSCLC (stage IIIB/IV) diagnosed between January 1, 2008 and January 1, 2015, initiated treatment with erlotinib or afatinib (first-line or second-line), and had disease progression. Monthly Medicare-paid costs were evaluated during the TKI therapy period and following progression. Results: The study included 364 patients. The total mean monthly cost during TKI therapy was $20,106 (95% confidence interval [CI] = $16,836–$23,376), of which 47.0% and 42.4% represented hospitalization costs and anti-cancer therapy costs, respectively. Following progression on TKI therapy (data available for 316 patients), total mean monthly cost was $19,274 (95% CI = $15,329–$23,218), and was higher in the 76.3% of patients who received anti-cancer therapy following progression than in the 23.7% of those who did not ($20,490 vs $15,364; p <.001). Among patients who received it, anti-cancer therapy ($11,198; 95% CI = $7,102–$15,295) represented 54.7% of total mean monthly cost. Among patients who did not receive anti-cancer therapy, hospitalization ($13,829; 95% CI = $4,922–$22,736) represented 90.0% of total mean monthly cost. Impaired performance status and brain metastases were significant predictors of increased cost during TKI therapy. Limitations: The study design may limit the generalizability of findings. Conclusions: Healthcare costs during TKI treatment and following progression appeared to be similar and were largely attributed to hospitalization and anti-cancer therapy. Notably, almost one-quarter of patients did not receive anti-cancer therapy following progression, potentially indicating an unmet need; hospitalization was the largest cost contributor for these patients. Additional effective targeted therapies are needed that could prolong progression-free survival, leading to fewer hospitalizations for EGFR mutation-positive patients.

Original languageEnglish (US)
Pages (from-to)192-200
Number of pages9
JournalJournal of Medical Economics
Volume21
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Non-Small Cell Lung Carcinoma
Health Care Costs
Lung Diseases
Observational Studies
Disease Progression
Costs and Cost Analysis
Protein-Tyrosine Kinases
Hospitalization
Therapeutics
Confidence Intervals
Neoplasms
Epidermal Growth Factor Receptor
Medicare
Disease-Free Survival
Medical Records
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy : a real-world observational study. / Skinner, Karen E.; Fernandes, Ancilla W.; Walker, Mark S.; Pavilack, Melissa; Ari, Vanderwalde.

In: Journal of Medical Economics, Vol. 21, No. 2, 01.02.2018, p. 192-200.

Research output: Contribution to journalArticle

@article{642802e7bbda4b1fa283b601d715f661,
title = "Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy: a real-world observational study",
abstract = "Aims: To assess healthcare costs during treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and following disease progression in patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective analysis of medical records of US community oncology practices was conducted. Eligible patients had advanced NSCLC (stage IIIB/IV) diagnosed between January 1, 2008 and January 1, 2015, initiated treatment with erlotinib or afatinib (first-line or second-line), and had disease progression. Monthly Medicare-paid costs were evaluated during the TKI therapy period and following progression. Results: The study included 364 patients. The total mean monthly cost during TKI therapy was $20,106 (95{\%} confidence interval [CI] = $16,836–$23,376), of which 47.0{\%} and 42.4{\%} represented hospitalization costs and anti-cancer therapy costs, respectively. Following progression on TKI therapy (data available for 316 patients), total mean monthly cost was $19,274 (95{\%} CI = $15,329–$23,218), and was higher in the 76.3{\%} of patients who received anti-cancer therapy following progression than in the 23.7{\%} of those who did not ($20,490 vs $15,364; p <.001). Among patients who received it, anti-cancer therapy ($11,198; 95{\%} CI = $7,102–$15,295) represented 54.7{\%} of total mean monthly cost. Among patients who did not receive anti-cancer therapy, hospitalization ($13,829; 95{\%} CI = $4,922–$22,736) represented 90.0{\%} of total mean monthly cost. Impaired performance status and brain metastases were significant predictors of increased cost during TKI therapy. Limitations: The study design may limit the generalizability of findings. Conclusions: Healthcare costs during TKI treatment and following progression appeared to be similar and were largely attributed to hospitalization and anti-cancer therapy. Notably, almost one-quarter of patients did not receive anti-cancer therapy following progression, potentially indicating an unmet need; hospitalization was the largest cost contributor for these patients. Additional effective targeted therapies are needed that could prolong progression-free survival, leading to fewer hospitalizations for EGFR mutation-positive patients.",
author = "Skinner, {Karen E.} and Fernandes, {Ancilla W.} and Walker, {Mark S.} and Melissa Pavilack and Vanderwalde Ari",
year = "2018",
month = "2",
day = "1",
doi = "10.1080/13696998.2017.1389744",
language = "English (US)",
volume = "21",
pages = "192--200",
journal = "Journal of Medical Economics",
issn = "1369-6998",
publisher = "Informa Healthcare",
number = "2",

}

TY - JOUR

T1 - Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy

T2 - a real-world observational study

AU - Skinner, Karen E.

AU - Fernandes, Ancilla W.

AU - Walker, Mark S.

AU - Pavilack, Melissa

AU - Ari, Vanderwalde

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Aims: To assess healthcare costs during treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and following disease progression in patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective analysis of medical records of US community oncology practices was conducted. Eligible patients had advanced NSCLC (stage IIIB/IV) diagnosed between January 1, 2008 and January 1, 2015, initiated treatment with erlotinib or afatinib (first-line or second-line), and had disease progression. Monthly Medicare-paid costs were evaluated during the TKI therapy period and following progression. Results: The study included 364 patients. The total mean monthly cost during TKI therapy was $20,106 (95% confidence interval [CI] = $16,836–$23,376), of which 47.0% and 42.4% represented hospitalization costs and anti-cancer therapy costs, respectively. Following progression on TKI therapy (data available for 316 patients), total mean monthly cost was $19,274 (95% CI = $15,329–$23,218), and was higher in the 76.3% of patients who received anti-cancer therapy following progression than in the 23.7% of those who did not ($20,490 vs $15,364; p <.001). Among patients who received it, anti-cancer therapy ($11,198; 95% CI = $7,102–$15,295) represented 54.7% of total mean monthly cost. Among patients who did not receive anti-cancer therapy, hospitalization ($13,829; 95% CI = $4,922–$22,736) represented 90.0% of total mean monthly cost. Impaired performance status and brain metastases were significant predictors of increased cost during TKI therapy. Limitations: The study design may limit the generalizability of findings. Conclusions: Healthcare costs during TKI treatment and following progression appeared to be similar and were largely attributed to hospitalization and anti-cancer therapy. Notably, almost one-quarter of patients did not receive anti-cancer therapy following progression, potentially indicating an unmet need; hospitalization was the largest cost contributor for these patients. Additional effective targeted therapies are needed that could prolong progression-free survival, leading to fewer hospitalizations for EGFR mutation-positive patients.

AB - Aims: To assess healthcare costs during treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and following disease progression in patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective analysis of medical records of US community oncology practices was conducted. Eligible patients had advanced NSCLC (stage IIIB/IV) diagnosed between January 1, 2008 and January 1, 2015, initiated treatment with erlotinib or afatinib (first-line or second-line), and had disease progression. Monthly Medicare-paid costs were evaluated during the TKI therapy period and following progression. Results: The study included 364 patients. The total mean monthly cost during TKI therapy was $20,106 (95% confidence interval [CI] = $16,836–$23,376), of which 47.0% and 42.4% represented hospitalization costs and anti-cancer therapy costs, respectively. Following progression on TKI therapy (data available for 316 patients), total mean monthly cost was $19,274 (95% CI = $15,329–$23,218), and was higher in the 76.3% of patients who received anti-cancer therapy following progression than in the 23.7% of those who did not ($20,490 vs $15,364; p <.001). Among patients who received it, anti-cancer therapy ($11,198; 95% CI = $7,102–$15,295) represented 54.7% of total mean monthly cost. Among patients who did not receive anti-cancer therapy, hospitalization ($13,829; 95% CI = $4,922–$22,736) represented 90.0% of total mean monthly cost. Impaired performance status and brain metastases were significant predictors of increased cost during TKI therapy. Limitations: The study design may limit the generalizability of findings. Conclusions: Healthcare costs during TKI treatment and following progression appeared to be similar and were largely attributed to hospitalization and anti-cancer therapy. Notably, almost one-quarter of patients did not receive anti-cancer therapy following progression, potentially indicating an unmet need; hospitalization was the largest cost contributor for these patients. Additional effective targeted therapies are needed that could prolong progression-free survival, leading to fewer hospitalizations for EGFR mutation-positive patients.

UR - http://www.scopus.com/inward/record.url?scp=85033502606&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033502606&partnerID=8YFLogxK

U2 - 10.1080/13696998.2017.1389744

DO - 10.1080/13696998.2017.1389744

M3 - Article

VL - 21

SP - 192

EP - 200

JO - Journal of Medical Economics

JF - Journal of Medical Economics

SN - 1369-6998

IS - 2

ER -