Trends in drug costs and overall survival in patients diagnosed with metastatic non-small cell lung cancer (NSCLC)

Background: The Value-Based Health Care (VBHC) concept defines patient value as patient relevant outcomes divided by costs. The aim of the present study is to explore systemic treatment costs versus overall survival (OS) over years. Methods: All patients diagnosed (in 2008-2014) with stage IV NSCLC and treated with systemic treatment in five Dutch large teaching hospitals (Santeon network) were included. We collected data on OS and amounts of drug units (mg) for every drug in the applied systemic cancer treatments up to death. These amounts were multiplied by Dutch unit costs (cost/mg) expressed in EUR 2018 to construct total drug costs per line of treatment per patient. Costs for day care visits were added, if applicable. Results: Data was collected from 983 patients. Figure 1 shows the mean total drug costs (split per line of treatment), median OS, and ratio between total costs and OS per year of diagnosis. The mean total drug costs per one year of survival ranged from €13.168 to €20.767 during the period under study. The use of maintenance therapy results in higher total drug costs in patients diagnosed in 2011 and 2012. Conclusion: This study shows that systemic treatment costs increase over time without survival improvements. Evaluating additional patient relevant outcomes such as quality of life will be helpful to better understand the added patient value of newer therapies in the future.