Real-world impact of brain metastases on healthcare utilization and costs in patients with non-small cell lung cancer treated with EGFR-TKIs in the US. (1st January 2021)

• Record Type: Journal Article
• Authors: Kong, Amanda M.; Pavilack, Melissa; Huo, Hairong; Shenolikar, Rahul; Moynihan, Meghan; Marchlewicz, Elizabeth H.; Chebili-Larson, Christina; Min, Stella; Subramaniam, Deepa S.
• Is Part Of: Journal of medical economics. Volume 24:Number 1(2021)
• Page Start: 328
• Page End: 338
• Publication Date: 2021-01-01
• Subjects: Non-small cell lung cancer -- epidermal growth factor receptor -- brain tumors -- healthcare costs; I -- Z; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2021.1885418
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Background: Non-small cell lung cancer (NSCLC) with brain metastases (BM) is difficult to treat and associated with poor survival. This study assessed the impact of BM on healthcare-related utilization and costs (HRUC) among patients receiving epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Patients and methods: Adults newly-diagnosed with metastatic NSCLC, initiating first-/second-generation EGFR-TKI treatment, with BM or no BM (NBM), were identified retrospectively from IBM MarketScan healthcare claims databases (2013–2017). HRUC were measured during the variable-length follow-up period. Generalized linear models assessed the impact of BM on total healthcare costs, standardized to 2017 US$. Results: Overall, 222 BM and 280 NBM patients were included, with a mean duration of follow-up of 14 months. Adjusted NSCLC-related and all-cause costs over average follow-up were 1.2 times higher among BM patients (Δ$5, 640 and Δ$6, 366, respectively; p <0.05); differences were driven primarily by radiation treatment and radiology. More than two times more BM than NBM patients received NSCLC-related radiation treatment, in both inpatient (15.3% vs 6.8%; p <0.05) and outpatient settings (87.8% vs 37.5%; p <0.05). Per-patient per-month (PPPM) radiation costs were also higher among BM patients, both inpatient ($796 vs $464, p =0.172) and outpatient ($2, 443 vs $747, p <0.05). All-cause PPPM radiology visits (2.0 vs 1.3) and associated costs ($3, 824 vs $1, 621) were higher among BM patients (both p <0.05). Conclusion: NSCLC-related HRUC, especially those attributable to radiation treatment, were higher among patients with BM. Future research should compare the potential for CNS-active EGFR-TKIs vs first-/second-generation EGFR-TKIs combined with radiotherapy to reduce HRUC.