Comparison of treatment patterns, health care utilization, and direct costs in elderly patients with distant-stage small cell lung cancer (SCLC) versus non-small cell lung cancer (NSCLC) using the SEER-Medicare database.

Abstract

7101 Background: Limited data exist on real-world treatment patterns, healthcare utilization, and associated costs of advanced SCLC among elderly patients in the US, and there are no recent comparisons between patients with advanced SCLC and advanced NSCLC. Methods: We retrospectively analyzed administrative claims data for elderly patients (≥65 years) from the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database for 2000-2008. Patients with a new diagnosis of distant stage lung cancer receiving cancer-directed therapy (ie, surgery, radiation, biologics, and/or chemotherapy) were grouped by tumor type (SCLC [n=5,855] vs NSCLC [n=24,090]). Survival was compared using Kaplan-Meier Log-rank; categorical measures with Chi-square statistics; and continuous measures with t-tests. Results: Compared to SCLC patients, a significantly greater proportion of patients with NSCLC received radiation therapy (75.6% vs 65.4%; p<0.001) and surgery (13.6% vs 7.8%; p<0.001). Chemotherapy was received by 85.5% of SCLC patients and 60.3% of NSCLC patients (p<0.001). Significantly higher proportions of SCLC patients also received red blood cell (20.7% vs 10.9; p<0.001) and platelet transfusions (5.6% vs 1.8%; p<0.001) as well as growth factor support (58.9% vs 39.5%; p<0.001). Survival did not differ significantly between groups (p=0.424), with the mean (10.4 months vs 11.1 months) and median (7.4 months vs 5.9 months) survival for SCLC and NSCLC noted accordingly. Total lifetime lung cancer-related costs ($44,167 vs $37,932; p<0.001) and all-cause costs ($70,548 vs $67,175; p<0.001) per patient for SCLC exceeded those for NSCLC. The primary drivers of cost included resource utilization across 3 care settings: hospitalizations, office visits, and hospital outpatient visits. Conclusions: Overall total lifetime and disease-related costs per advanced SCLC and NSCLC patient were high, and costs for SCLC exceeded those for NSCLC. Survival estimates coupled with per patient costs for both cancers underscores the unmet medical need for patients with distant stage SCLC and NSCLC.