Health care utilization and economic burden of dermatologic adverse drug reactions (ADRs) in patients with NSCLC treated with an epidermal growth factor receptor inhibitor (EGFRI).

Abstract

e16571 Background: Non Small Cell Lung Cancer (NSCLC) patients treated with EGFRI therapies may develop dermatologic ADRs. ADRs negatively affect patients’ quality of life, require medical care, and may lead to a substantial economic burden. The objective of this study is to assess the economic burden of dermatologic ADRs in patients with NSCLC. Methods: Continuously enrolled adult patients with ≥ 1 NSCLC diagnosis initiated on an EGFRI therapy (i.e., erlotinib, gefitinib) were selected from a large US claims dataset. Patients were classified into two mutually exclusive cohorts depending on whether or not they had dermatologic ADR during the period following EGFRI initiation. Dermatologic ADRs were identified using ICD-9-CM codes. Patients were observed from the index date up to the end of the health plan enrollment, or data availability, or 90 days after the EGFRI discontinuation, whichever occurred first. Incidence rate ratios (IRRs) for healthcare resource utilization were estimated using Poisson regression models. Incremental costs (2010 USD) were estimated on a monthly basis using generalized linear or two-part models. Multivariate regressions controlled for age, gender, comorbidities, and baseline healthcare utilization and costs. Results: A total of 635 and 2,688 patients were included in the dermatologic ADR and ADR-free cohorts, respectively. After adjusting for confounding factors, compared to patients in the ADR-free cohort, patients in the ADR cohort had higher incidence of emergency room visits (IRR=1.28 ( CI 1.13-1.45); p=.0001),higher incidence of outpatient visits (IRR=1.28 (1.25-1.3); p<.0001), and higher incidence of other medical services ( IRR=1.15 (1.11-1.19); p<.0001). Moreover, patients in the ADR cohort incurred higher total healthcare costs by an estimated $3,210 (p=.003) per patient per month. Conclusions: ComparedtoADR-free patients, dermatologic ADR patients with NSCLC incurred a substantial economic burden related to higher healthcare resource utilization and costs. Efforts to improve the dermatologic side effect profile of EGFRI are needed to control this burden.