Abstract
We evaluated the survival rates and medical expenditure in patients with lung cancer using a nationwide claims database in South Korea. A retrospective observational cohort study design was used, and 2,919 lung cancer patients and their matched controls were included. Medical expenditures were analyzed with the Kaplan-Meier sample average method, and patients were categorized into 4 groups by operation and primary treatment method (i.e. Patients with operation: OP = surgery, OP+CTx/RTx = surgery with anti-cancer drugs or radiotherapy; Patients without operation: CTx/RTx = anti-cancer drugs or radiotherapy, Supportive treatment). The 5-year medical expenditure per case was highest in the OP+CTx/RTx group ($36,013), followed by the CTx/RTx ($23,134), OP ($22,686), and supportive treatment group ($3,700). Lung cancer-related anti-cancer drug therapy was the major cost driver, with an average 53% share across all patients. Generalized linear regression revealed that monthly medical expenditure in lung cancer patients, after adjustment for follow-up month, was approximately 3.1–4.3 times higher than that in the control group (cost ratio for OP = 3.116, OP+CTx/RTx = 3.566, CTx/RTx = 4.340, supportive treatment = 4.157). The monthly medical expenditure at end of life was estimated at $2,139 for all decedents, and approximately a quarter of patients had received chemotherapy in the last 3 months. In conclusion, this study presented the quantified treatment costs of lung cancer on various aspects compared with matched controls according to the treatment of choice. In this study, patients with operation incurred lower lifetime treatment costs than patients with CTx/RTx or supportive treatment, indicating that the economic burden of lung cancer was affected by treatment method. Further studies including both cancer stage and treatment modality are needed to confirm these results and to provide more information on the economic burden according to disease severity.
Highlights
Global lung cancer deaths were estimated at 1.7 million in 2015, contributing to approximately 20% of all cancer-related deaths [1, 2]
The treatment costs for new biologics are very high if they are prescribed without any restrictions, and their cost-effectiveness should be evaluated to assess the priorities of target patients and to set up the treatment budget [9]
It is important to analyze current costs for lung cancer and evaluate the areas in which improvement is needed in order to efficiently manage treatment costs in the future
Summary
Global lung cancer deaths were estimated at 1.7 million in 2015, contributing to approximately 20% of all cancer-related deaths [1, 2]. As is the case worldwide, lung cancer is the leading cause of cancer deaths in Korea, accounting for 23% of all cancer deaths even though its prevalence share is relatively low at 4.3% of all cancers [3]. This is related to the high mortality rate and delayed diagnosis of lung cancer. The treatment costs for new biologics are very high if they are prescribed without any restrictions, and their cost-effectiveness should be evaluated to assess the priorities of target patients and to set up the treatment budget [9]. It is important to analyze current costs for lung cancer and evaluate the areas in which improvement is needed in order to efficiently manage treatment costs in the future
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