Background Recent advances in therapy have created numerous options for the 1L treatment of aNSCLC. This study describes the total direct healthcare costs for patients treated with immunotherapy monotherapy (IO), chemotherapy (CT), or immunotherapy plus chemotherapy (IO+CT) in the 1L setting.

Methods The Ability Patient Complete claims database was used to identify US patients aged ≥ 18 years diagnosed with aNSCLC (ICD-9: 162.*; ICD-10: C34.*) initiating 1L treatment with IO, CT, or IO+CT between January 2015 and May 2019. Patients were required to have at least 6 months of continuous enrollment prior to initiation of 1L treatment, ≥ 1 inpatient or 2 outpatient claims for lung cancer, and a claim within 45 days for a secondary metastatic site. Patients with another malignant primary cancer, who participated in a clinical trial, or who received treatments consistent with small cell lung cancer or a systemic therapy not used for lung cancer were excluded. Costs were calculated on a per-patient per month (PPPM) basis from initiation of 1L treatment until discontinuation or end of study period and expressed in 2019 US dollars. A standardized cost approach was applied, with average wholesale prices for antineoplastic and other drug costs and CMS fee schedules for outpatient visits, inpatient stays, ED visits, and other medical costs (e.g. all other outpatient medical services including infusions of growth factors, radiographic studies, blood draws, etc.). All antineoplastic costs were considered individually.

Results 8,154 patients were included in the cohort: 1,319 received IO, 5,315 CT, and 1,520 IO+CT. By cohort, mean age was 65 (IO), 63 (CT), and 62 (IO+CT) years while mean Charlson Comorbidity Index was 2.12, 2.11, and 1.83, respectively. Key results by healthcare resource utilization category are provided in the table below (table 1).

Conclusions The total PPPM healthcare costs of patients receiving chemotherapy (CT or IO+CT) are higher than those only receiving IO monotherapy. These differences are driven by higher outpatient visit, other medical, and pharmacy costs. IO-containing regimens have higher antineoplastic costs than CT, but options with no or limited CT may be able to offset these costs through a reduction in other medical expenses.