Therapies recently approved to treat advanced-stage non-small cell lung cancer (NSCLC) confer an average of 1.5-month survival increase and an $8,000 increase in outpatient spending per patient, according to a study published in the Journal of Clinical Oncology (February 2017;35[5]:529-525).
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Multiple agents for advanced-stage NSCLC have been approved by the US Food and Drug Administration (FDA) in the past decade, including pemetrexed, erlotinib, and bevacizumab. However, little is known about improved survival outcomes and associated spending with these drugs in a real-world setting.
Cathy Bradley, PhD, associate director for population sciences research, University of Colorado Cancer Center, and colleagues conducted a comparative analysis of the costs and efficacy of these newer approved drugs versus three older drugs—paclitaxel, gemcitabine, and vinorelbine. Researchers used SEER-Medicare data for 22,163 patients aged 65 years or older who were newly diagnosed with advanced-stage NSCLC and treated with antineoplastic agents between 2000 and 2011. Percentage of patients who received each agent, days while on treatment, survival, and spending in the 12 months after diagnosis were estimated.
Results of the analysis showed a significant increase in the use of pemetrexed (39.2%), erlotinib (20.3%), and bevacizumab (18.9%) as well as a decline in paclitaxel (58% to 39%), gemcitabine (32% to 17%), and vinorelbine (24% to 6%) during the 12-year study period. Average total of days on therapy increased by 5 days (103 days to 108 days), especially for those patients who received the newer therapies (146 days vs 75 days for those who did not receive those agents). Acute inpatient spending declined from $29,376 to $23,731 (approximately $5600 per person), whereas outpatient spending increased 23% from $37,931 to $46,642 (approximately $8700 per person). Median survival gains for those patients receiving the newer therapies was approximately 1.5 months (7.7 months to 9.2 months, P < .001).
Researchers concluded that a shift in preferred treatment of advanced-stage NSCLC has resulted in modest gains in survival at high costs. However, this does not imply that newer treatment options are unsuccessful, they said.
“It means that despite their promise in clinical trials, they haven’t made a survival difference in the population. That may be because oncologists are giving them to people who will not benefit. Better predicting who will benefit from newer, more expensive therapies is essential to making value-based decisions in the context of very high costs and new medicines,” explained Dr Bradley in a press release.
