PCN221 - STAGE III UNRESECTABLE NON-SMALL CELL LUNG CANCER TREATMENT PATTERNS AND COSTS: AN ONTARIO, CANADA ANALYSIS

Abstract

With recent changes in the treatment of Stage III, non-small cell lung cancer (NSCLC), understanding the economic impact from a public payers’ perspective is key. A longitudinal, population-level study was carried out to determine baseline treatment patterns and health system costs prior to the introduction of emerging treatments. Patients diagnosed between April 1, 2010 and March 31, 2015 were identified in the Ontario Cancer Registry. Stage III patients were unresectable if no surgery was undertaken within 3 months of diagnosis. Initial treatments included radiation (RT), targeted therapy, chemotherapy, concurrent and sequential chemo+RT (cCRT, sCRT). Costs from provincial administrative databases included inpatient hospitalizations, cancer clinic visits, physician services, and 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 from the Institute for Clinical Evaluative Sciences called GETCOST. Short-term episodes (e.g., hospital-based) calculate costs by multiplying the encounter’s resource intensity weight by an annual cost per weighted case, 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 costs were attributable to NSCLC. 4,542 (18.4%) of the 24,729 patients identified were Stage III unresectable (median age 70yr, 54.2% male). Treatment distribution was: cCRT (21.6%), palliative RT (21.3%), curative RT (20.2%), no treatment (19.6%), chemotherapy (11.6%), sCRT (4.9%) and targeted therapy (0.7%). The overall total cost was $396.9M (mean cost per patient= $87,393); 68.4% of total costs ($271.3M) were incurred in the first year. Cost drivers were inpatient hospitalizations ($108.4M), cancer clinic visits ($107.5M), and physician services ($56.9M). cCRT was only administered in 21.6% of Stage III unresectable patients, even though considered the standard of care and chemotherapies were not a cost driver in this cohort.