In advanced NSCLC, treatment refusal leads to increased health care utilization

A new report highlights how treatment decisions for non-small cell lung cancer (NSCLC) affect healthcare utilization and patient costs.

A significant percentage of people with non-small cell lung cancer (NSCLC) remain untreated for their cancers, and these patients tend to require more hospital and emergency room visits than people who receive cancer treatment, according to a new report.

The findings, which were presented recently at the Academy of Managed Care Pharmacy’s Nexus 2022 conference, offer new insights into the economic impact of NSCLC treatment decisions.

Julie Vanderpoel, PharmD, MPA, of Janssen Scientific Affairs and colleagues noted that NSCLC accounts for up to 85% of all lung cancers. While therapies such as surgery, radiation therapy and chemotherapy have long been part of lung cancer care, newer treatment options include targeted therapy and immunotherapy, the authors note. Yet the availability of new treatments has failed to reverse the stark survival data for NSCLC. Only 26 percent of people with NSCLC are alive after 5 years, and the numbers are significantly lower for people with stage III and IV NSCLC, Vanderpoel and colleagues note. For patients who choose treatment, the mean and median survival is only about 6 months.

The researchers wanted to understand how the current treatment environment for people with NSCLC translates into health care resource use and costs, both for people with NSCLC in general and for people who choose for or against treatment. To find out, they consulted the claims databases of both commercial insurers and Medicare and Medicaid, and retrospectively analyzed patient costs both before and after a patient’s lung cancer diagnosis. The study included patients diagnosed after January 1, 2015, to ensure the report reflects recent trends.

A total of 32,019 patients met all study inclusion criteria, and 12,501 of these patients had advanced NSCLC. Patients had a mean age of 67.2 years, and the advanced group had a mean age of 65.7 years. The mean baseline Quan-Charlson comorbidity index score of participants was 2.1 for the entire cohort and 1.7 for the advanced NSCLC group. None of the patients had metastatic disease at baseline, according to study protocols. During the 12-month baseline period before diagnosis, participants had an average all-cause health care cost of $1,857 per patient per month (PPPM), and those with advanced disease had an average index period health care cost of $1,387 PPPM .

Overall, 65% of patients in the study received treatment for their cancers over a median follow-up period of 13.3 months. About half (50.7%) of participants experienced metastatic disease during the post-index evaluation period, including 56% of people who received treatment and 40.7% of people who did not receive treatment.

Among people with advanced cancer, 69.2% received treatment for a median follow-up of 9.5 months. Of these, 94.2% of treated patients and 100% of untreated patients reported metastatic disease.

Of all patients, surgery to remove the tumor is the most common treatment. Among the advanced cohort, radiotherapy and antineoplastic therapy are most common.

The researchers found that the cohort with advanced NSCLC had higher health care utilization. In both the overall and advanced cohorts, those who were not treated had higher rates of inpatient hospital stays, longer hospital stays and more emergency room visits, Vanderpoel and colleagues found.

Overall, patients had a median cost per PPPM of $14,591, and those with advanced cases had a median cost of $22,350 PPPM. Among all patients, treated patients had slightly above-average costs ($15,050 PPPM), but untreated patients had slightly lower costs ($13,740), a reduction in costs attributable to lower pharmacy costs.

However, among patients with advanced cancer, treated patients had lower than average costs of $21,973 PPPM, while those who were not treated had PPPM costs of $23,196.

The authors say that the increased hospital use of untreated patients, particularly those with advanced cancer, may be an indication of poorer quality of life in this population.

“These findings have important implications for population health decision-makers regarding the value of innovative drugs on outcomes and quality of care for patients with advanced NSCLC,” the authors conclude.


Vanderpoel J, Vadagam P, Emond B, et al. Health care utilization and costs for untreated patients with non-small cell lung cancer and advanced non-small cell lung cancer. Presented at: AMCP Nexus 2022; October 11-14, 2022; National Harbor, MD. Summary C11.

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