Comparison of demographics, treatment patterns, health care utilization, and costs among elderly patients with extensive-stage small cell and metastatic non-small cell lung cancers.
BACKGROUND
Limited data exist regarding real-world treatment patterns, resource utilization, and costs of extensive-stage small cell lung cancer (esSCLC) among elderly patients in the United States. While abundant data are available on treatment patterns in metastatic non-small cell lung cancer (mNSCLC), to our knowledge no data exist comparing costs and resource use between patients with esSCLC or mNSCLC.


METHODS
We retrospectively analyzed administrative claims data (2000-2008) of patients aged ≥65 years from the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database. Patients were selected on the basis of having newly diagnosed esSCLC (n=5,855) or mNSCLC (n=24,090) during 1/1/2000-12/31/2005, and were required to have received cancer-directed therapy. Survival and other measures were compared between esSCLC and mNSCLC patients using Kaplan-Meier log-rank and univariate chi-square and t-tests. Study measures were followed from first diagnosis date of either esSCLC or mNSCLC until the earlier of death or end of the database.


RESULTS
Survival between the cohorts did not differ significantly: mean of 10.4 months for esSCLC patients versus 11.1 months for mNSCLC; median survival was 7.4 months versus 5.9 months. A higher percentage of mNSCLC patients (vs. esSCLC) received radiation therapy (75.6% vs. 65.4%; P < 0.001) and surgery (13.6% vs. 7.8%; P < 0.001) during the metastatic disease period. Conversely, a higher percentage of esSCLC patients than mNSCLC patients received chemotherapy (85.5% vs. 60.3%; P < 0.001), red blood-cell transfusion (20.7% vs. 10.9%; P < 0.001), platelet transfusion (5.6% vs. 1.8%; P < 0.001), and growth-factor support (59.0% vs. 39.5%; P < 0.001). esSCLC patients incurred higher lifetime disease-related costs ($44,167 vs. $37,932; P < 0.001) and all-cause costs ($70,549 vs. $67,176; P < 0.001) than mNSCLC patients.


CONCLUSIONS
Lifetime total and disease-related costs per patient were high. Increased use of chemotherapy, supportive care therapies (including growth factors), and disease-related hospitalizations were observed in esSCLC patients as compared with mNSCLC patients. Disease-related and all-cause costs for esSCLC also exceeded those of mNSCLC, except for hospice and skilled nursing services. Survival and per-patient costs for both groups underscore the unmet medical need for more effective therapies in patients with esSCLC or mNSCLC.
RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC, 27709, USA. sudeepkarve@gmail.com.
Sudeep J
SJ
Karve
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, Indian. price_gregory_l@lilly.com.
Gregory L
GL
Price
RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC, 27709, USA. kldavis@rti.org.
Keith L
KL
Davis
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, Indian. pohl_gerhardt@lilly.com.
Gerhardt M
GM
Pohl
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, Indian. nash_smyth_emily@lilly.com.
Emily Nash
EN
Smyth
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, Indian. bowman_lee_lb@lilly.com.
Lee
L
Bowman
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000191:economics*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000191:economics* / Q000628:therapy*; D014481:United States