Factors associated with use of high-cost agents for the treatment of metastatic non-small cell lung cancer

Abstract

Background: Antineoplastic agents approved in recent decades are a marked advancement in cancer treatment, but they come at considerable cost. These drugs may widen survival disparities between patients who receive these agents and those who do not. We examine factors associated with the use of high-cost antineoplastic agents for the treatment of metastatic non-small cell lung cancer. Methods: We conducted a retrospective observational study using 2007-2015 Surveillance, Epidemiology, and End-Results- Medicare data supplemented with the Area Health Resource File. Patients were aged 66 years and older, were enrolled in feefor- service Medicare Part D, were diagnosed with a first primary diagnosis of metastatic non-small cell lung cancer, and had received an antineoplastic agent. "High-cost agents"were defined as agents costing $5000 or more per month. Independent variables include race/ethnicity, urban or rural residency, census tract poverty, and treatment facility type (eg, National Cancer Institute designation). Results: Patients who lived in areas of high poverty were 4 percentage points less likely to receive high-cost agents (two-sided P