The average cost of treatment according to lung cancer stage using real-world data

ABSTRACT

Introduction: Immunotherapy led to increased survival in advanced non-small cell lung cancer; however, it has also increased treatment costs. In this study, real-world data was used to evaluate the average cost of treatment of patients with lung cancer.

Material and Methods: This is a retrospective study that extracted patient-level data from a Brazilian Oncology Group database. The inclusion criteria were patients with non-small cell lung cancer from stage I-IV, and that received at least one line of treatment from 2018 to 2019. The primary endpoint was the average cost of treatment according to the disease stage, and secondary endpoints were the average cost of each line of treatment among patients with advanced disease, and the percentage of this amount that was related to immunotherapy acquisition. The study also assessed overall survival and the cost-effectiveness of immunotherapy at first-line versus immunotherapy at second-line or beyond, that was presented as the incremental cost effectiveness ratio per quality-adjusted life years.

Results: Fifty patients were included, being four (8%) at early-stage (I and II), 10 (20%) at locally advanced disease (III) and 36 (72%) at advanced-stage (IV). The average costs of treatment for each disease stage were respectively US$30,040, US$52,162, and US$95,607 (p=0.071). Among patients with advanced disease that received IO, the average cost of the entire treatment was highest with immunotherapy at first line (US$116,623) compared with immunotherapy at second-line (US$112,967) or third-line (US$37,279). Immunotherapy at first-line resulted in an estimated additional 0.26 quality-adjusted life years compared to immunotherapy at second-line (US$19,240).

Conclusion: The cost of treating non-small cell lung cancer is higher as more advanced is the neoplasm stage at diagnosis. Regarding immunotherapy, the cost of treatment is higher as earlier the treatment is performed, even tough, the cost-effectiveness ratio for first-line treatment seems to be favorable compared to second-line treatment.

RESUMO

Introdução: A imunoterapia levou ao aumento da sobrevida no câncer de pulmão avançado de células não pequenas; no entanto, também aumentou os custos do tratamento. Neste estudo, foram utilizados dados do mundo real para avaliar o custo médio do tratamento de pacientes com câncer de pulmão.

Material e Métodos: Este é um estudo retrospectivo que extraiu dados de pacientes de um banco de dados do Grupo Brasileiro de Oncologia. Os critérios de inclusão foram pacientes com câncer de pulmão de células não pequenas em estágio I-IV, e que receberam pelo menos uma linha de tratamento de 2018 a 2019. O desfecho primário foi o custo médio do tratamento de acordo com o estágio da doença, e os desfechos secundários foram o custo médio de cada linha de tratamento entre pacientes com doença avançada e o percentual desse valor relacionado à aquisição de imunoterapia. O estudo também avaliou a sobrevida global e a relação custo-eficácia da imunoterapia de primeira linha versus imunoterapia de segunda linha ou mais, que foi apresentada como a relação custo-eficácia incremental por anos de vida ajustados pela qualidade.

Resultados: Foram incluídos 50 pacientes, sendo quatro (8%) em estágio inicial (I e II), 10 (20%) com doença localmente avançada (III) e 36 (72%) em estágio avançado (IV). Os custos médios do tratamento para cada estágio da doença foram respectivamente de US$30.040, US$52.162 e US$95.607 (p=0,071). Entre os pacientes com doença avançada que receberam imunoterapia, o custo médio de todo o tratamento foi mais alto com imunoterapia de primeira linha (US$116.623) em comparação com imunoterapia de segunda linha (US$112.967) ou terceira linha (US$37.279). A imunoterapia de primeira linha resultou em um adicional estimado de 0,26 anos de vida ajustados pela qualidade em comparação com imunoterapia de segunda linha (US$19.240).

Conclusão: O custo do tratamento do câncer de pulmão avançado de células não pequenas é maior quanto mais avançado é o estágio da neoplasia no momento do diagnóstico. Em relação à imunoterapia, o custo do tratamento é mais elevado, pois o tratamento é realizado mais precocemente, embora a relação custo-efetividade do tratamento de primeira linha pareça ser favorável em comparação ao tratamento de segunda linha.

Keywords:

Lung neoplasms - Cost-benefit analysis - Immunotherapy - Database management systems - Big data

Descritores:

Neoplasias pulmonares - Análise custo-benefício - Imunoterapia - Sistemas de Gerenciamento de Banco de Dados - Banco de dados

Publication History

Received: 11 May 2023

Accepted: 26 October 2023

Article published online:
29 December 2023

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