JCO Study Identifies Increased Duration of Treatment in Medicare Patients With NSCLC

Non—small cell lung cancer (NSCLC) has seen significant advances in treatment options over the past decade. According to a new study, significant shifts in the treatment of advanced-stage NSCLC is accompanied by only modest gains in survival and total Medicare spending.

For their study, the authors used the SEER-Medicare data for elderly patients who had a new diagnosis of advanced NSCLC and were subsequently treated between 2000 and 2011. For the duration of their study, the authors noted a marked shift in treatment, with a quick adoption of pemetrexed (39.2%), erlotinib (20.3%), and bevacizumab (18.9%). There was a simultaneous decrease in use of paclitaxel (38.7%), gemcitabine (17.0%), and vinorelbine (5.7%). Overall, duration of treatment increased by an average of 5 days, with patients on bevacizumab, erlotinib, or pemetrexed having the longest treatment on average (146 days, compared with 75 days for those who did not receive these agents).

While carboplatin was the most commonly prescribed agent for advanced NSCLC over that entire study period, the use of pemetrexed, bevacizumab, and erlotinib also increased in popularity.

Acute inpatient spending for this patient cohort decreased from $29,376 to $23,731, a decrease of more than $5000 per patient. Outpatient spending, however, increased from $37,931 to $46,642. For patients who had Medicare Part D prescription coverage, Part D total gross spending increased from $6617 in 2007 to $8177 in 2011—a 24% increase. Total Medicare spending for Part D beneficiaries saw a 9% increase between 2007 and 2011.

Survival, on the other hand, saw a slight increase of just 1.5 months.

The authors conclude that understanding practice patterns for highly prevalent cancers, such as advanced NSCLC, is important to study. “More evidence is needed to weight the benefit of these agents against their costs and the possibility of savings with lower prices and lower inpatient use,” they wrote.

Reference

Bradley CJ, Yabroff KR, Mariotto AB, Zeruto C, Tran Q, Warren JL. Antineoplastic treatment of advanced-stage non—small-cell lung cancer: treatment, survival, and spending (2000 to 2011) [published online January 3, 2017]. J Clin Oncol.