egfr突变晚期或转移性非小细胞肺癌患者的医疗资源使用、医疗费用和未满足需求

IF 2.3 Q2 ECONOMICS

Journal of Health Economics and Outcomes Research Pub Date : 2025-08-29 eCollection Date: 2025-01-01 DOI:10.36469/001c.142771

David Waterhouse, Iris Li, Laura Morrison, Bruno Emond, Marie-Hélène Lafeuille, Annalise Hilts, Jill Korsiak, Patrick Lefebvre, Pratyusha Vadagam, Dexter Waters

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Unmet needs for patients treated with tyrosine kinase inhibitors (TKIs) for EGFRm (Ex19del/L858R) advanced NSCLC, including osimertinib, are relevant to US population health decision makers.Objectives: To describe healthcare resource utilization (HRU) and costs by line of therapy (LOT) among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating first-line (1L) treatment.Methods: IBM MarketScan® Research Databases (1/1/2010-1/31/2023) were used to select adult patients with advanced NSCLC initiating an EGFR-TKI during any LOT on/after 4/18/2018 (osimertinib approval; EGFRm Ex19del/L858R proxy). Per-patient-per-month (PPPM) all-cause HRU and costs were described in 1L, second-line (2L), and third-line (3L) overall and among subgroups receiving 1L osimertinib monotherapy or platinum-based chemotherapy (PBC) without immunotherapy, separately.Results: The study included 409 patients with EGFRm advanced NSCLC (mean age, 60.5 years; 70.2% female). In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of >4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). Mean all-cause costs PPPM were <math><mn>27</mn> <mrow><mo> </mo></mrow> <mn>751</mn> <mi>i</mi> <mi>n</mi> <mn>1</mn> <mi>L</mi> <mo>,</mo></math> 28 971 in 2L, and <math><mn>31</mn> <mrow><mo> </mo></mrow> <mn>251</mn> <mi>i</mi> <mi>n</mi> <mn>3</mn> <mi>L</mi> <mo>.</mo> <mi>A</mi> <mi>m</mi> <mi>o</mi> <mi>n</mi> <mi>g</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mn>1</mn> <mi>L</mi> <mi>o</mi> <mi>s</mi> <mi>i</mi> <mi>m</mi> <mi>e</mi> <mi>r</mi> <mi>t</mi> <mi>i</mi> <mi>n</mi> <mi>i</mi> <mi>b</mi> <mi>m</mi> <mi>o</mi> <mi>n</mi> <mi>o</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>r</mi> <mi>a</mi> <mi>p</mi> <mi>y</mi> <mi>s</mi> <mi>u</mi> <mi>b</mi> <mi>g</mi> <mi>r</mi> <mi>o</mi> <mi>u</mi> <mi>p</mi> <mo>,</mo> <mi>m</mi> <mi>e</mi> <mi>a</mi> <mi>n</mi> <mi>P</mi> <mi>P</mi> <mi>P</mi> <mi>M</mi> <mi>c</mi> <mi>o</mi> <mi>s</mi> <mi>t</mi> <mi>s</mi> <mi>w</mi> <mi>e</mi> <mi>r</mi> <mi>e</mi></math> 27 610 in 1L, <math><mn>35</mn> <mrow><mo> </mo></mrow> <mn>501</mn> <mi>i</mi> <mi>n</mi> <mn>2</mn> <mi>L</mi> <mo>,</mo> <mi>a</mi> <mi>n</mi> <mi>d</mi></math> 36 618 in 3L. Among the 1L PBC subgroup (n = 58), mean PPPM costs were <math><mn>23</mn> <mrow><mo> </mo></mrow> <mn>820</mn> <mi>i</mi> <mi>n</mi> <mn>1</mn> <mi>L</mi> <mo>,</mo></math> 24 788 in 2L, and $23 348 in 3L.Discussion: Among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating 1L, each successive LOT was shorter and more costly.Conclusions: Findings highlight the importance of using the most effective 1L treatments to delay disease progression and reduce HRU and costs.","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"98-107"},"PeriodicalIF":2.3000,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399230/pdf/","citationCount":"0","resultStr":"{\"title\":\"Healthcare Resource Use, Healthcare Costs, and Unmet Needs Among Patients Treated for EGFR-Mutated Advanced or Metastatic Non-small Cell Lung Cancer.\",\"authors\":\"David Waterhouse, Iris Li, Laura Morrison, Bruno Emond, Marie-Hélène Lafeuille, Annalise Hilts, Jill Korsiak, Patrick Lefebvre, Pratyusha Vadagam, Dexter Waters\",\"doi\":\"10.36469/001c.142771\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor-mutated (EGFRm) NSCLC, 84% of which are exon 19 deletions (Ex19del)/exon 21 substitutions (L858R). 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In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of >4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). 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引用次数: 0

摘要

背景：约17%的非小细胞肺癌（NSCLC）患者为表皮生长因子受体突变（EGFRm）型NSCLC，其中84%为外显子19缺失(Ex19del)/外显子21替换（L858R）。EGFRm （Ex19del/L858R）晚期NSCLC患者未满足的酪氨酸激酶抑制剂（TKIs）治疗需求，包括奥西替尼，与美国人口健康决策者相关。目的：描述EGFRm （Ex19del/L858R）晚期NSCLC患者开始一线（1L）治疗的医疗资源利用率（HRU）和费用（LOT）。方法：使用IBM MarketScan®研究数据库（2010年1月1日- 2023年1月31日）选择2018年4月18日/之后任何LOT期间启动EGFR-TKI的晚期NSCLC成年患者（奥西替尼批准；EGFRm Ex19del/L858R代理）。每个患者每月（PPPM）的全因HRU和成本分别在1L、二线（2L）和三线（3L）总体上和接受1L奥西替尼单药治疗或铂基化疗（PBC）不进行免疫治疗的亚组中进行描述。结果：该研究纳入409例EGFRm晚期NSCLC患者（平均年龄60.5岁，70.2%为女性）。在1L中，72.9%的患者开始了基于奥西替尼的治疗（2L, 45.9%; 3L, 41.2%）， 21.0%的患者开始了化疗（2L, 30.0%; 3L, 36.5%）， 4.6%的患者开始了另一种EGFR-TKI (2L, 12.9%; 3L, 12.9%)， 1.5%的患者开始了免疫治疗（2L, 11.2%; 3L, 9.4%）。总体而言，170例（41.6%）进展为2L，其中85例（50.0%）进展为3L。平均LOT持续时间随每次LOT的延长而减少（1L， 10.2个月；2L， 8.7个月；3L， 8.0个月）。在所有批次中，患者的平均门诊次数PPPM为4840次（1L, 4.79; 2L, 4.26; 3L, 4.40）， 1L单药治疗亚组（n = 279）在1L期间的平均住院天数PPPM为0.69天（2L, 0.82; 3L, 0.74）。平均全因成本PPPM为27 751 i / 1 L， 28 971 / 2L, 31 251 / 3 L。m o n g t h e 1 L o s i m e r t i n i b m o n o t h e r p y s u b g r o p m e n p p p m c o s t s w e r e 27 610年1 L,我35 501 n 2 L, n d 36 618 3 L。在1L PBC亚组（n = 58）中，1L的平均PPPM成本为23 820美元，2L为24 788美元，3L为23 348美元。讨论：在EGFRm （Ex19del/L858R）晚期NSCLC患者中，每次连续LOT的时间更短，费用更高。结论：研究结果强调了使用最有效的1L治疗来延缓疾病进展、降低HRU和成本的重要性。

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Healthcare Resource Use, Healthcare Costs, and Unmet Needs Among Patients Treated for EGFR-Mutated Advanced or Metastatic Non-small Cell Lung Cancer.

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Healthcare Resource Use, Healthcare Costs, and Unmet Needs Among Patients Treated for EGFR-Mutated Advanced or Metastatic Non-small Cell Lung Cancer.

Background: Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor-mutated (EGFRm) NSCLC, 84% of which are exon 19 deletions (Ex19del)/exon 21 substitutions (L858R). Unmet needs for patients treated with tyrosine kinase inhibitors (TKIs) for EGFRm (Ex19del/L858R) advanced NSCLC, including osimertinib, are relevant to US population health decision makers.

Objectives: To describe healthcare resource utilization (HRU) and costs by line of therapy (LOT) among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating first-line (1L) treatment.

Methods: IBM MarketScan® Research Databases (1/1/2010-1/31/2023) were used to select adult patients with advanced NSCLC initiating an EGFR-TKI during any LOT on/after 4/18/2018 (osimertinib approval; EGFRm Ex19del/L858R proxy). Per-patient-per-month (PPPM) all-cause HRU and costs were described in 1L, second-line (2L), and third-line (3L) overall and among subgroups receiving 1L osimertinib monotherapy or platinum-based chemotherapy (PBC) without immunotherapy, separately.

Results: The study included 409 patients with EGFRm advanced NSCLC (mean age, 60.5 years; 70.2% female). In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of >4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). Mean all-cause costs PPPM were $27 751 i n 1 L,$ 28 971 in 2L, and $31 251 i n 3 L . A m o n g t h e 1 L o s i m e r t i n i b m o n o t h e r a p y s u b g r o u p, m e a n P P P M c o s t s w e r e$ 27 610 in 1L, $35 501 i n 2 L, a n d$ 36 618 in 3L. Among the 1L PBC subgroup (n = 58), mean PPPM costs were $23 820 i n 1 L,$ 24 788 in 2L, and $23 348 in 3L.