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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:https://doi.org/10.1016/j.jtocrr.2023.100487
Economic Burden of Recurrence Among Resected Medicare Patients With Early Stage Non-Small Cell Lung Cancer
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      ABSTRACT

      Introduction

      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.

      Methods

      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.

      Results

      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.

      Conclusion

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

      Keywords

      Abbreviations:

      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)

      Article info

      Publication history

      Accepted: February 19, 2023
      Received in revised form: January 24, 2023
      Received: October 14, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Jay M. Lee, [email protected];

      Rongrong Wang, [email protected];

      Ann Johnson, [email protected];

      Sarika Ogale, [email protected];

      Matthew Kent, [email protected];

      Janet S. Lee, [email protected]

      Research Support

      This study was sponsored by Genentech Inc, a member of the Roche Group.

      Disclosure

      JML received research support for this study provided by Genentech Inc, a member of the Roche Group; consulting fees from AstraZeneca, Genentech, and Roche; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Genentech, and Roche; support for attending meetings and/or travel from Genentech; patents planned, issued, or pending with UCLA; participation on a Data Safety Monitoring Board or Advisory Board for AstraZeneca, Bristol-Myers Squibb, Genentech, Novartis, and Roche; stock or stock options for Moderna; and receipt of medical writing and research support from Genentech and Roche. RW, AJ, SO, and JSL are employees and stockholders of Genentech Inc, a member of the Roche Group. MK is an employee of Genesis Research, which received research funding for this study from Genentech Inc, a member of the Roche Group.

      Jay M. Lee: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – reviewing & editing. Rongrong Wang: Data Curation, Formal Analysis, Investigation, Methodology, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing. Ann Johnson: Conceptualization, Funding Acquisition, Investigation, Supervision, Visualization, Writing – review & editing. Sarika Ogale: Formal Analysis, Investigation, Methodology, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing. Matthew Kent: Data Curation, Formal Analysis, Software, Validation, Visualization, Writing – review & editing. Janet S. Lee: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Writing – original draft, Writing – review and editing.

      Identification

      DOI: https://doi.org/10.1016/j.jtocrr.2023.100487

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of the International Association for the Study of Lung Cancer.

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