PCN163 Acute Healthcare Utilization and Costs After Initiating First-line Targeted Therapy for Metastatic Lung Cancer in the US

Abstract

This study aims to 1) assess the frequency of acute healthcare utilization (HCU) and costs after initiating first-line targeted therapy for metastatic lung cancer; and 2) identify factors related to the risk of acute HCU. We identified patients with metastatic lung cancer treated with targeted therapy as first-line treatment between 2012 and 2019 from the IBM MarketScan Research Databases, a large US administrative claims database. Acute HCU including emergency room (ER) and unplanned inpatient (IP) events were identified within 30 days of initiating first-line targeted therapy. HCU due to potentially preventable causes (anemia, sepsis, pneumonia, fever, dehydration, pain, nausea, emesis, diarrhea, and neutropenia) was identified according to the criteria by Centers for Medicare & Medicaid Services (CMS). Adjusted logistic regression models were performed to determine factors associated with preventable HCU. Among the study cohort of 2,946 eligible patients, 24% had acute HCU within 30 days of targeted therapy initiation. Approximately 47% of these acute events were due to preventable causes. The preventable events resulted in a total reimbursed cost of $3,393,419, which accounted for 52% of the total acute HCU costs. Factors associated with a higher risk of preventable HCU included insurance type (odds ratio [OR] 2.55, 95% CI 1.47-4.42 for Medicaid vs. Commercial), ER/IP visits within the last 30 days (OR 1.40, 95% CI 1.07-1.83), increased types of non-oncology drugs (OR 1.99, 95% CI 1.33-2.98 for ≥8 types vs. 0-3), and a history of sepsis (OR 2.13, 95%CI 1.36-3.35), heart arrhythmias (OR 1.41, 95% CI 1.01-1.96), or vertebral fractures (OR 1.71, 95%CI 1.05-2.79) in the previous year. Half of the acute HCU after initiating first-line targeted therapy for metastatic lung cancer are potentially preventable. Targeting higher-risk patients with personalized supportive care within the clinical workflow may reduce preventable HCU, lower costs, and improve care delivery.