Immune Checkpoint Inhibitor Regimens Drive Higher Costs in First-Line NSCLC Treatment
First-line (1L) treatment with immune checkpoint inhibitors (ICIs), particularly in combination with chemotherapy, is the most frequently used and costliest systemic therapy for metastatic non-small cell lung cancer (NSCLC) patients without actionable mutations in the US, according to a study published in Current Oncology.
Previous studies report on the burden of illness in US clinical practice for patients with metastatic NSCLC, but most focus on second or later lines of therapy.
“The current study aims to address this knowledge gap by evaluating real-world treatment patterns, healthcare resource utilization (HCRU), and healthcare costs, specifically among patients receiving SACTs for the 1L treatment of metastatic NSCLC without actionable alterations in the US,” wrote Divyan Chopra, Amgen, Thousand Oaks, CA, and coauthors.
This retrospective cohort study, conducted using Optum’s deidentified Clinformatics® claims database, evaluated 15 659 patients aged ≥18 years who initiated 1L systemic anticancer therapy (SACT) for metastatic NSCLC between January 2020 and March 2023. All patients were publicly or privately insured and did not harbor targetable genetic alterations. The majority (86%) were covered by Medicare Advantage, and the mean age was 71.7 years.
The most common 1L regimens included ICI + platinum-based chemotherapy (PBCT) (47.0%), PBCT alone or in combination (26.4%), and ICI monotherapy or dual therapy (19.7%). Median duration of treatment was 4.2 months, and mean time to next treatment for those who continued care was 8.0 months.
Chemotherapy-only regimens were associated with the highest health care resource utilization (HCRU), including outpatient visits (mean 10.5 per patient per month [PPPM]), inpatient admissions (0.16 PPPM), and emergency department (ED) visits (0.16 PPPM). Approximately 74% of outpatient encounters were NSCLC-related.
All-cause health care costs during 1L treatment averaged $32 215 PPPM (SD $44 597), with the highest costs incurred by ICI + non-PBCT regimens ($38 454 PPPM), followed by ICI + PBCT ($34 721 PPPM). Most expenses originated in outpatient settings, particularly for regimens containing ICIs, where outpatient costs reached $32 913 PPPM. Inpatient costs were also elevated for chemotherapy-based regimens, peaking at $4725 PPPM for PBCT-based therapy.
NSCLC-specific costs mirrored these findings, averaging $26 231 PPPM, with outpatient services again being the primary driver.
“The 1L treatment of metastatic NSCLC continues to impose a notable HCRU burden on patients, caregivers, and healthcare systems, as well as an economic burden for payers, highlighting the need for better treatment options in this setting,” concluded the study authors.
Reference
Chopra D, Waterhouse DM, Sultan I, Stollenwerk B. Real-world treatment patterns, healthcare resource utilization, and healthcare costs in the first-line treatment of metastatic non-small cell lung cancer in the US. Curr Oncol. 2025;32(3):151. doi:10.3390/curroncol32030151
