Cost of care in first line advanced NSCLC patients: Chemotherapy vs targeted therapy

Abstract

Background: Targeted therapies have increasingly placed drug cost in the spotlight. This represents only one aspect of cancer treatment cost. To provide a comprehensive view, we analyzed first-year drug costs, procedures and acute care interventions for a NSCLC patients on chemo vs TT in the 1L setting. Methods: Using Inovalon's MORE2 Registry® US claims data, aNSCLC pts were identified by International Classification of Diseases-9 codes from July 2013 to June 2014. Inclusion: aNSCLC pts >18 years who received 1L systemic therapy within 6 months (mo) of diagnosis. Exclusion: pts with small-cell lung cancer or secondary malignancies, clinical trial pts, pts with <12 mo follow-up, and cost outliers (2.5% on both ends of the cost curve). Wholesale acquisition cost (WAC) and average sales price (ASP) were used to determine drug costs; the Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (OPPS) were used for procedure costs. Descriptive statistics were used to analyze costs from 1L start to beginning of second line (2L) treatment or last claim if 2L therapy was not initiated within the 12 mo follow-up. TT included erlotinib, ceritinib, afatinib, crizotinib or bevacizumab monotherapy. Results: Of 5319 1L pts, 1070 (20%) had ≥12 mo of follow-up and were included in the analysis. Of those, 23% received TT (242 pts); 62% (659 pts) incurred inpatient costs. Results of the analysis are presented in the table. Conclusions: The study showed considerable TC in 1L aNSCLC, with systemic therapy representing a significant share. Pts with inpatient care incurred higher TC, and chemo pts had a higher share of inpatient costs vs TT pts. Alternatives to traditional chemo may allow for savings across non-drug-related outpatient and inpatient costs.(Table Presented).