Abstract
Purpose
Non-small cell lung cancer (NSCLC) is a condition with significant clinical burden for patients and relevant economic impact. Limited evidence exists on the management costs of NSCLC patients, especially in the late phases of the disease. The main objective of this analysis was to evaluate the economic impact of clinical management of NSCLC patients in the Italian population.
Methods
This evaluation was an economic analysis of the observational and multicentre study LIFE, which described the therapeutic approach in routine clinical practice for NSCLC patients, progressing after first-line treatment. This study evaluated resource consumption in different Italian hospitals, including specialist visits, hospitalizations, accesses to first aid, pharmacological treatment, laboratory tests and palliative care. The National Healthcare Service perspective was adopted.
Results
In this study, N = 191 patients enrolled in the LIFE study were included. Patients were aged 64.2 years and were predominantly males (66%). In the different line of treatments, monthly costs of patients ranged between €1471 (first line) and €1788 (third line). The overall healthcare cost over the average period of observation (16.4 months) was €25,859 per patient. Overall, oncology therapy was the cost driver, although the composition of medical costs changed across the different lines of treatment, with costs for concomitant medication and palliative care being predominant in late phase of the disease.
Conclusions
The economic burden of NSCLC is extremely high during the overall period of treatment, and a significant level of care is required in each stage of the disease.
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References
American Cancer Society (ACS) (2016) Targeted therapies for non-small cell lung cancer. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-treating-targeted-therapies. Accessed 7 Dec 2016
Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, Chow LQ, Vokes EE, Felip E, Holgado E, Barlesi F, Kohlhäufl M, Arrieta O, Burgio MA, Fayette J, Lena H, Poddubskaya E, Gerber DE, Gettinger SN, Rudin CM, Rizvi N, Crinò L, Blumenschein GR Jr, Antonia SJ, Dorange C, Harbison CT, Graf Finckenstein F, Brahmer JR (2015) Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 373(17):1627–1639. doi:10.1056/NEJMoa1507643
de Marinis F, Ardizzoni A, Fontanini G, Grossi F, Cappuzzo F, Novello S, Santo A, Lorusso V, Cortinovis D, Iurlaro M, Galetta D, Gridelli C, LIFE Study Team (2014) Management of Italian patients with advanced non-small-cell lung cancer after second-line treatment: results of the longitudinal phase of the LIFE observational study. Clin Lung Cancer 15(5):338–345.e1. doi:10.1016/j.cllc.2014.04.004
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403. doi:10.1016/j.ejca.2012.12.027
Garon EB, Rizvi NA, Hui R, Leighl N, Balmanoukian AS, Eder JP, Patnaik A, Aggarwal C, Gubens M, Horn L, Carcereny E, Ahn MJ, Felip E, Lee JS, Hellmann MD, Hamid O, Goldman JW, Soria JC, Dolled-Filhart M, Rutledge RZ, Zhang J, Lunceford JK, Rangwala R, Lubiniecki GM, Roach C, Emancipator K, Gandhi L, KEYNOTE-001 Investigators (2015) Pembrolizumab for the treatment of non-small-cell lung cancer. N Engl J Med 372(21):2018–2028. doi:10.1056/NEJMoa1501824
Gatzemeier U, Pluzanska A, Szczesna A, Kaukel E, Roubec J, De Rosa F, Milanowski J, Karnicka-Mlodkowski H, Pesek M, Serwatowski P, Ramlau R, Janaskova T, Vansteenkiste J, Strausz J, Manikhas GM, Von Pawel J (2007) Phase III study of erlotinib in combination with cisplatin and gemcitabine in advanced non-small-cell lung cancer: the Tarceva Lung Cancer Investigation Trial. J Clin Oncol 25(12):1545–1552
Gridelli C, de Marinis F, Ardizzoni A, Novello S, Fontanini G, Cappuzzo F, Grossi F, Santo A, Cortinovis D, Favaretto A, Lorusso V, Galetta D, Siena S, Bettini A, Iurlaro M, Caprioli A, LIFE Study Team (2014) Advanced non-small cell lung cancer management in patients progressing after first-line treatment: results of the cross-sectional phase of the Italian LIFE observational study. J Cancer Res Clin Oncol 140(10):1783–1793. doi:10.1007/s00432-014-1715-2
Italian Association of Cancer Registries (AIRTUM). The numbers of cancer in Italy: year 2013. http://www.registri-tumori.it/cms/it/node/2888. Accessed 7 Dec 2016
Italian Association of Cancer Registries (AIRTUM). The numbers of cancer in Italy: year 2014. http://www.registri-tumori.it/cms/it/node/3412. Accessed 7 Dec 2016
Italian Association of Medical Oncology (AIOM). Lung cancer guidelines. http://www.aiom.it/area+pubblica/area+medica/prodotti+scientifici/linee+guida/1%2C333%2C1%2C. Accessed 7 Dec 2016
Italian Drug Agency (AIFA), National Observatory on Drugs Use (OSMED). The use of drugs in Italy: report 2013. http://www.agenziafarmaco.gov.it/it/content/luso-dei-farmaci-italia-rapporto-osmed-2013. Accessed 7 Dec 2016
Italian Institute of Statistics (ISTAT). Inflation coefficients. http://rivaluta.istat.it/Rivaluta/. Accessed 7 Dec 2016
Italian Ministry of Health (2007) Project Mattoni SSN. First aid and system 118, methodological proposal for the evaluation of the emergency costs. http://www.mattoni.salute.gov.it/mattoni/documenti/11_Valutazione_costi_dell_emergenza.pdf
Italian Ministry of Health (2013a) Hospital service tariffs. Supplement no. 8; Official Gazette no. 23, January 28, 2013
Italian Ministry of Health (2013b) Outpatient service tariffs. Supplement no. 8; Official Gazette no. 23, January 28, 2013
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90. doi:10.3322/caac.20107
Lee DH, Park K, Kim JH, Lee JS, Shin SW, Kang JH, Ahn MJ, Ahn JS, Suh C, Kim SW (2010) Randomized Phase III trial of gefitinib versus docetaxel in non-small cell lung cancer patients who have previously received platinum-based chemotherapy. Clin Cancer Res 16(4):1307–1314. doi:10.1158/1078-0432
Luengo-Fernandez R, Leal J, Gray A, Sullivan R (2013) Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol 14(12):1165–1174
MedlinePlus (2014) Medical encyclopedia. Lung cancer—non-small cell cancer. Last reviewed: August 31, 2014
National Institute of Tumors. Incidence, mortality and prevalence of lung cancer in Italy. http://www.tumori.net/it3/rapporti%20sedi/Polmone.pdf. Accessed 7 Dec 2016
Navada S, Lai P, Schwartz AG, Kalemkerian GP (2006) Temporal trends in small cell lung cancer: analysis of the national Surveillance Epidemiology and End-Results (SEER) database (abstract 7082). J Clin Oncol 24(18 Suppl):384S
Perrone F, Benelli G, Lopatriello S, Portalone L, Salvati F, Zorat P, Negrini C (2004) Cost of non-small cell lung cancer in Italy. Results of the longitudinal study ALCEA (Advanced Lung Cancer Economic Assessment). In: Journal of Clinical Oncology, ASCO Annual Meeting Proceedings (post-meeting edition), vol 22(14S) (July 15 Supplement), pp 8265
Schnipper LE, Smith TJ, Raghavan D, Blayney DW, Ganz PA, Mulvey TM, Wollins DS (2012) American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 30(14):1715–1724. doi:10.1200/JCO.2012.42.8375
Schwander B, Ravera S, Giuliani G, Nuijten M, Walzer S (2012) Cost comparison of second-line treatment options for late stage non-small-cell lung cancer: cost analysis for Italy. Clinicoecon Outcomes Res 4:237–243. doi:10.2147/CEOR.S34371
Sequist LV, Yang JC, Yamamoto N, O’Byrne K, Hirsh V, Mok T, Geater SL, Orlov S, Tsai CM, Boyer M, Su WC, Bennouna J, Kato T, Gorbunova V, Lee KH, Shah R, Massey D, Zazulina V, Shahidi M, Schuler M (2013) Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol 31(27):3327–3334. doi:10.1200/JCO.2012.44.2806
Shaw AT, Kim DW, Nakagawa K, Seto T, Crinó L, Ahn MJ, De Pas T, Besse B, Solomon BJ, Blackhall F, Wu YL, Thomas M, O’Byrne KJ, Moro-Sibilot D, Camidge DR, Mok T, Hirsh V, Riely GJ, Iyer S, Tassell V, Polli A, Wilner KD, Jänne PA (2013) Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med 368(25):2385–2394. doi:10.1056/NEJMoa1214886
Sher T, Dy GK, Adjei AA (2008) Small cell lung cancer. Mayo Clin Proc 83(3):355–367. doi:10.4065/83.3.355
Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML (2008) Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst 100:888–897
Acknowledgements
The authors acknowledge Valentina Acciai from Boehringer Ingelheim Italia and Christian Amici, Chiara Longagnani, Sara Montanari, Alessandra Ori, Saide Sala Lucia Simoni, and Francesca Trevisan, from MediNeos S.U.R.L., for support in designing and managing the study.
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All the authors equally contributed to designing the study protocol; collecting data; analysing and interpreting the results; drafting the manuscript; revising the manuscript for important intellectual content.
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All the authors declare no conflicts of interest. Boehringer Ingelheim provided funding for the editorial support of this article.
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This article does not contain any studies with human participants or animals performed by the author.
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Consent to data handling for research purpose at time of first visit was required for the study. Patients not consenting for personal data handling for research purpose were excluded.
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Migliorino, M.R., Santo, A., Romano, G. et al. Economic burden of patients affected by non-small cell lung cancer (NSCLC): the LIFE study. J Cancer Res Clin Oncol 143, 783–791 (2017). https://doi.org/10.1007/s00432-016-2326-x
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DOI: https://doi.org/10.1007/s00432-016-2326-x