PCN210 - USING REAL WORLD DATA TO DETERMINE HEALTH SYSTEM COSTS OF A 5-YEAR NON-SMALL CELL LUNG CANCER COHORT

Abstract

With the recent advances in the treatment of advanced non-small cell lung cancer (NSCLC) and fiscal constraints of publicly funded healthcare systems, understanding the real world economic impact of lung cancer is increasingly important. The objective of this study was to determine the health system costs of a 5-year cohort of NSCLC patients treated in Ontario, Canada. Patients diagnosed between April 1, 2010 and March 31, 2015 were identified in the Ontario Cancer Registry and linked to provincial administrative databases, capturing hospitalizations, cancer clinic visits, physician services and expensive chemotherapies. Activity level reporting of radiation and inexpensive chemotherapies was not reported. Total cohort, annual and mean per patient costs (CAD 2017) were determined using a costing methodology available at the Institute for Clinical Evaluative Sciences called GETCOST. Short-term episodes (e.g., hospital-based encounters) calculate costs by multiplying the encounter’s resource intensity weight by an annual cost per weighted case for total costs, long-term episodes (e.g., complex continuing care) calculate costs by weighted days, and costs of visit-based encounters are determined at utilization. It was assumed that costs were attributable to NSCLC. 24,729 NSCLC patients were identified (median age 70yr; 48.5% female; stage I=20.7%, II=9.3%, III=20.8%, IV=49.2%). The overall total cost was $1.9B (mean cost per patient= $76,816); inpatient hospitalizations ($635.2M), cancer clinic visits ($323.7M) and physician services ($301.4M) were the top three cost contributors while the total cost of expensive chemotherapies was $61.5M. Year 1 after diagnosis had the highest costs ($1.3B) followed by year 2 ($316.3M). Mean cost per patient varied by stage, being highest for stage II ($94,553) and lowest for stage IV ($66,652). Real world costs during the 5-year period (prior to the use of immuno-oncology drugs) were substantial even with poor survival of NSCLC patients and those receiving no active treatment.