Research Article|Articles in Press, 100487

Economic Burden of Recurrence Among Resected Medicare Patients With Early Stage Non-Small Cell Lung Cancer

Open AccessPublished:February 24, 2023DOI:
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      Patients with early non-small cell lung cancer (eNSCLC) who experience recurrence are associated with worse survival outcomes, but the economic burden of recurrence is not well characterized. This study evaluated the incremental healthcare resource utilization (HCRU) and costs of recurrence in Medicare patients with resected eNSCLC.


      This retrospective observational study used Surveillance, Epidemiology, and End Results cancer registry data linked with Medicare claims. Eligible patients were ≥65 years old with newly diagnosed NSCLC Stages IB-IIIA (AJCC Cancer Staging Manual, 7th edition) and surgery between January 2010 and December 2017. Continuous enrollment criteria were applied to ensure appropriate data capture. Per-patient per-month (PPPM) HCRU and all-cause direct costs were compared for patients with vs without recurrence, which was identified from claims data using diagnosis, procedure, or drug codes. Patients were matched 1:1 using exact matching on cancer stage and treatment, and propensity score matching on other characteristics.


      In total, 2035 (44%) out of 4595 patients had evidence of recurrence. After matching, 1494 patients were included in each cohort. Patients with recurrence had a significantly higher number of inpatient visits (+0.25 PPPM), outpatient visits (+1.10 PPPM), physician services (+3.70 PPPM), and emergency department visits (+0.25 PPPM; all P<0.001). Average follow-up PPPM cost in the recurrence cohort was $7437 and $1118 in the no recurrence cohort, resulting in a difference of $6319 PPPM (P<0.001) with inpatient costs as the largest contributor.


      Based on a real-world population, recurrence among eNSCLC resected patients is associated with significantly increased HCRU and costs.



      CI (confidence interval), ED (emergency department), eNSCLC (early non-small cell lung cancer), HCRU (health care resource utilization), HMO (health maintenance organization), NOS (not otherwise specified), NSCLC (non-small cell lung cancer), OS (overall survival), PPPM (per-patient per-month), PSM (propensity score matching), SD (standard deviation), SMD (standardized mean difference)