Economic burden of advanced non-small cell lung cancer (NSCLC): a systematic literature review
Nick Jovanoski, Gavneet Kaur, Hemlata Shukla, Neeti Chana & Saifuddin Kharawala
Aims: A systematic review of the economic burden of advanced non-small-cell lung
cancer (NSCLC).
Methods: Articles from 2011 onwards reporting the economic burden of locally
advanced (stage IIIB/C)/metastatic (stage IV) NSCLC were identified through systematic
and supplementary searches. Outcomes included hospitalizations, emergency department
(ED) and outpatient visits, and direct and indirect costs, amongst others.
Results: Across 50 publications (43 studies), patients with advanced NSCLC had high
rates of healthcare resource utilization (HCRU), with most reporting hospitalization
(ranging from 13.0% to 98.2% of patients), ED visits (2.5% to 83.1%), outpatient visits
(74.6% to 100.0%), and diagnostic or monitoring tests (45.9% to 92.0%). HCRU (hospitalizations,
ED visits and pharmacy visits) appeared to be lower with immunotherapy
as compared to chemotherapy. Brain/central nervous system (CNS) metastases were
the major clinical factor influencing HCRU. Mean direct costs ranged from US$5,647
(Brazil) to US$158,908 (US) over 12–24months, and were generally higher in the US,
Korea, Germany, and the UK (vs. Brazil, France, and Italy). The main direct cost drivers
were drug-related costs (9.5–76.0% of total), overall outpatient costs (39–70.6%), and
inpatient costs (5.0–58.1%). Costs were higher for chemotherapy than for immunotherapy.
In China, indirect medical costs were US$1,413 per case. In general, mean total
healthcare costs were higher for metastatic disease. Disease severity/diagnosis, presence
of brain/CNS metastases, targeted therapy and chemotherapy (vs. immunotherapy)
and the presence of comorbidities were the main factors influencing higher
costs.
Limitations and conclusions: Patients with advanced NSCLC had high rates of HCRU,
and costs were substantial, though varying greatly across countries. HCRU and costs
were higher in patients with brain/CNS metastases. Since this was a qualitative review,
no formal quantitative synthesis was attempted. Costs reported in different currencies
and heterogeneity across studies limited comparability. Finally, a single reviewer
extracted data.
