Population-based patterns and cost of management of metastatic non-small cell lung cancer after completion of chemotherapy until death.
BACKGROUND
The aim of this study was to examine the patterns and costs of management of non-small cell lung cancer (NSCLC) after completion of chemotherapy until death in a population of patients in Manitoba, Canada.


METHODS
Stage IIIB and IV NSCLC patients diagnosed between January 1997 and June 2000 who received chemotherapy as the primary treatment, completed their chemotherapy and survived for at least 28 days since their last treatment, and were on best supportive care (BSC) were selected. Treatment, services received, costs, and survival were determined by chart review and examining various databases including the Manitoba Cancer Registry, medical claims, hospitalizations, and prescription drugs. Costs of treatment, average cost per patient, and lifetime treatment costs were calculated.


RESULTS
Of the 2463 patients diagnosed with NSCLC over the study period, 150 patients matched our study criteria. From the beginning of the first chemotherapy treatment, the median survival time was 31.8 weeks, while from the date of BSC the median survival time was 13.8 weeks. The average cost per case was $10,805 from last date of chemotherapy and $8654 during the BSC period. The average cost per patient-month ranged from $1645 to $1792 in current prices. Lifetime treatment costs ranged from $8702 to $11,057. Hospitalizations accounted for 80% of the total treatment costs.


CONCLUSIONS
The largest overall component of cost after the end of chemotherapy was hospitalizations. Effective new therapies that reduce the episodes of hospitalizations would have a significant impact on decreasing aggregate costs.
Navaratnam
Sri
S
Department of Internal Medicine, University of Manitoba, Faculty of Medicine, 675 McDermot Avenue, Winnipeg, R3E 0V9 Canada. sri.navaratnam@cancercare.mb.ca
Kliewer
Erich V
EV
Butler
Jim
J
Demers
Alain A
AA
Musto
Grace
G
Badiani
Ketan
K
D000368:Aged; D002170:Canada; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics*; D015331:Cohort Studies; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D008297:Male; D008499:Medical Records; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging