Costs of first-line doublet chemotherapy and lifetime medical care in advanced non-small-cell lung cancer in the United States.
OBJECTIVE
The purpose of this study was to identify total lifetime medical-care costs and costs associated with first-line chemotherapy treatment among older patients with stage IIIB/IV non-small-cell lung cancer treated with commonly used two-drug chemotherapy ("doublet") regimens in the United States.


METHODS
Study patients included individuals aged 65 years and older who received a diagnosis of stage IIIB/IV non-small-cell lung cancer in a Surveillance, Epidemiology and End Results cancer registry between 1997 and 2002 and who received first-line treatment with commonly used doublet regimens. Patients were followed retrospectively in the Surveillance, Epidemiology and End Results-Medicare database to evaluate lifetime medical-care costs and costs while on first-line chemotherapy treatment. Pairwise comparisons of treatment costs were estimated by using nonparametric bootstrap methods.


RESULTS
Lifetime medical-care costs totaled approximately $70,000 and on-treatment costs for first-line chemotherapy totaled approximately $30,000 among study patients and were dominated by hospitalization and physician costs. Lifetime costs were significantly higher among patients treated with first-line cisplatin/carboplatin (platinum) plus a taxane compared with those who received platinum plus gemcitabine [difference: $4781 ($1558-$8039)] or other doublet therapy [difference: $5961 ($2333-$9614)]. Total on-treatment costs for first-line chemotherapy were significantly higher among patients treated with platinum plus a taxane compared with those who received platinum plus gemcitabine [difference: $5825 ($3872-$7770)], platinum plus another agent [difference: $5968 ($3995-$7975)], or another doublet therapy [difference: $3663 ($1620-$5740)].


CONCLUSIONS
There is a cost differential between first-line doublet regimens in terms of lifetime and on-treatment costs. Although doublet therapy with platinum and a taxane was the most frequently utilized regimen, it was associated with the highest lifetime and on-treatment costs.
Lang
Kathleen
K
i3 Innovus, Medford, MA, USA.
Marciniak
Martin D
MD
Faries
Douglas
D
Stokes
Michael
M
Buesching
Don
D
Earle
Craig
C
Treat
Joseph
J
Babineaux
Steve
S
Morissette
Nathalie
N
Thompson
David
D
D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001952:Bridged-Ring Compounds / Q000008:administration & dosage / Q000191:economics; D016190:Carboplatin / Q000008:administration & dosage / Q000191:economics; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics*; D002945:Cisplatin / Q000008:administration & dosage / Q000191:economics; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics*; D008297:Male; D011159:Population Surveillance; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics; D014481:United States; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D001952:Bridged-Ring Compounds; D043823:Taxoids; D003841:Deoxycytidine; C080625:taxane; D016190:Carboplatin; D002945:Cisplatin; D000093542:Gemcitabine