Economic Burden and Provider Referral Patterns Among Patients with Unresectable Stage III EGFR-Mutated NSCLC Receiving Chemoradiotherapy in the United States.

Introduction: Among patients with unresectable stage III non-small cell lung cancer (NSCLC), those whose tumors harbor epidermal growth factor receptor mutations (EGFRm) are associated with comparatively fewer treatment options and worse prognosis. With the recent approval of targeted treatment, characterizing the economic burden and EGFRm testing and provider referral patterns is crucial to understanding the unmet needs of these patients.

Methods: This was a retrospective analysis of Optum's Market Clarity Dataset from January 1, 2018 to June 30, 2023. Eligibility criteria included diagnosis with unresectable stage III EGFRm NSCLC and chemoradiotherapy (CRT) initiation (index date) within 90 days. Primary outcomes were per patient per month (PPPM) all-cause and NSCLC-related health care resource utilization (HCRU) and costs, and EGFRm testing and provider referral patterns.

Results: A total of 144 patients were followed for a median of 15.5 months; 56.3% of patients underwent EGFRm testing before CRT initiation. All-cause and NSCLC-related costs during follow-up were $28,020 and $22,816 PPPM, respectively. Ambulatory utilization was the major driver of this economic burden. Pharmacy costs accounted for $4244 (15.1%) and $3736 (16.4%) of the total all-cause and NSCLC-related costs, respectively. Between diagnosis and CRT initiation, the most common specialties visited were oncology/hematology (seen by 67.4% of patients), radiology (26.4%), pulmonology (22.2%), and cardiology (21.5%). Patients who visited three or more specialties on separate days before CRT initiation had a median time to CRT initiation of 33.0 days versus 22.0 days when patients visited multiple specialties on the same day (suggestive of a multidisciplinary care team, MDT).

Conclusion: Patients with unresectable stage III EGFRm NSCLC incur substantial economic burden, especially in ambulatory HCRU and costs. With the recent approval of targeted treatment for these patients, reflex EGFRm testing in all early-stage NSCLC at diagnosis is encouraged. Our results also suggest MDT involvement may improve completeness in diagnosis and staging, resulting in acceleration of treatment planning and management.