P2.02-013 Costing Analysis of PROCLAIM Non–Small Cell Lung Cancer Trial Data

Abstract

Standard care in inoperable stage III non-small-cell lung cancer (NSCLC) is concurrent chemoradiation. In the PROCLAIM trial, comparing concurrent pemetrexed-cisplatin (PemCis) and thoracic radiotherapy (TRT) followed by consolidation pemetrexed versus etoposide-cisplatin (EtoCis) and TRT followed by a consolidation platinum doublet in patients with locally advanced NSCLC, PemCis experienced significantly lower incidence of drug-related grade 3-4 adverse events (AE) and had similar resource use. Here, we estimate healthcare resource use costs associated within the PROCLAIM trial. Unit costs were applied to patient-level resource use (study drug, hospitalizations, radiotherapy, concomitant medications, laboratory tests, other procedures) to estimate total costs to a third-party US payer. Unit costs (in 2015 US dollars) were derived from publicly-available sources. Costs were compared using the nonparametric Wilcoxon rank sum test; sensitivity analyzes were conducted. A subgroup analysis excluded patients with unusually long hospitalizations. PemCis had significantly higher total costs than EtoCis (Table). While other medical costs were lower for PemCis in the concurrent phase, other medical costs were comparable for PemCis and EtoCis during the overall treatment mainly because PemCis patients remained in the trial longer (0.37 years) than EtoCis patients (0.29 years). Results were similar in the subgroup analysis.Tabled 1ParameterOverall Arm A Mean (SD)Overall Arm B Mean (SD)Concurrent Phase Arm A Mean (SD)Concurrent Phase Arm B Mean (SD)Years follow-up0.37 (0.12)0.29 (0.09)0.20 (0.04)0.19 (0.05)Costs:Total$51,313.90 ($33,166.11)$22,425.24 ($26,087.53)$28,856.03 ($25,745.12)$17,526.22 ($23,307.13)Study treatment$31,203.67 ($11,217.62)$2,957.81 ($900.48)$15,719.30 ($3,447.07)$1,872.54 ($289.21)Other medicala$20,110.22 ($32,883.10)$19,467.43 ($26,141.99)$13,136.73 ($25,725.51)$15,653.68 ($23,325.07)Adverse-event-relatedb$16,681.48 ($30,964.72)$16,061.84 ($24,356.95)$10,665.83 ($24,139.67)$13,139.85 ($21,860.09)Hospitalization$15,141.15 ($29,937.04)$13,562.54 ($23,156.58)$9,839.42 ($23,488.47)$11,778.76 ($21,007.19)Concomitant medication$3,158.12 ($3,615.92)$4,238.32 ($5,242.10)$2,032.67 ($2,064.07)$2,498.43 ($2,997.28)Monthly other-medical costs$4,529.33$5,594.09$5,473.64$6,865.65SD = standard deviation. aOther medical includes hospitalizations, radiotherapy, supportive care, concomitant medications, laboratory/evaluation/radiology visits, and blood products. bAdverse-event-related includes concomitant medications, hospitalizations, and blood products associated with an adverse event specifically; subset of other medical costs. Open table in a new tab SD = standard deviation. aOther medical includes hospitalizations, radiotherapy, supportive care, concomitant medications, laboratory/evaluation/radiology visits, and blood products. bAdverse-event-related includes concomitant medications, hospitalizations, and blood products associated with an adverse event specifically; subset of other medical costs. Higher total costs for PemCis compared to EtoCis were driven by study drug cost. However, other medical costs during the concurrent phase were lower for PemCis due to significantly lower hospitalization costs and lower concomitant medications use. When adjusting for overall treatment duration, other medical costs were favorable for PemCis. Pemetrexed patients may incur lower monthly other medical costs due to reduced hospitalization costs.