FIRST AND SECOND LINE LUNG CANCER TREATMENT UTILIZATION PATTERNS AND ASSOCIATED COSTS IN A UNITED STATES HEALTH CARE CLAIMS DATABASE

Because treatment options for lung cancer are changing rapidly, it is important to understand current treatment patterns and cost implications. We conducted a retrospective claims analysis to identify common lung cancer regimens and direct medical costs in a large US commercial health insurance and Medicare Advantage database. We identified patients with lung cancer receiving 1st or 2nd line chemotherapy between January 2006 to December 2010 using an algorithm utilizing enrolment records and ICD-9 codes. A patient flow algorithm was constructed to define treatment cohorts. Patients were stratified based on the lung cancer drug treatment received following diagnosis and first line therapy. Total costs are report for the 1 year follow up period after initiation of drug treatment. A total of 2739 lung cancer patients were included in the analysis; 53% >65 yr. Paclitaxel or docetaxel plus platinum were the most commonly utilized 1st line regimens. Pemetrexed plus docetaxel was the most common 2nd line treatment. Among patients receiving 1st line treatment and remaining enrolled in the health plan, only 16.7% received 2nd line treatment. Total costs (average +/− SD) in the year following chemotherapy initiation was $70,205 ± 66,956 (range $50,000-$120,000) for those with 1 line of therapy versus $93,432± $66,208 (range $62,000-$169,000) with two or more lines. For all patients, average ambulatory care costs (which included IV administration costs) were $34,449±40,847, intravenous drug costs ($17,246± 27,488), and inpatient hospital costs (14,180 ±$31,409) comprised the largest proportion of costs in the year following chemotherapy initiation. In this analysis, few lung cancer patients received 2nd line treatment.. For those patients who received 2nd line treatment and beyond, direct medical care costs are over $23,000 higher over years 2006-10 compared to those receiving only one line. Ambulatory costs comprised the greatest proportion of total costs (50%).