This study evaluated the economic burden of metastatic non-small cell lung cancer patients before and after the availability of an immuno-oncology (IO) regimen as a first-line (1L) treatment. Patients from 2014 to 2020 were categorized according to mutational status into mutation-positive and negative/unknown groups, which were further divided into pre-1L IO and post-1L IO sub-groups depending on the availability of pembrolizumab monotherapy in 1L. Healthcare costs and HCRU for a 1L treatment and overall follow-up were reported as the mean total and per-month cost per patient by groups. Of 644 patients, 125were mutation-positive and 519 negative/unknown (229 and 290 in pre- and post-1L IO, respectively). The mean total per-patient cost in 1L was lower in pre- (EUR 7804) and post-1L IO (EUR 19,301) than the mutation-positive group (EUR 45,247), persisting throughout overall disease follow-up. However, this difference was less when analyzing monthly costs. Therapy costs were the primary driver in 1L, while hospitalization costs rose during follow-up. In both mutation-positive and post-IO 1L groups, the 1L costs represented a significant portion (70.1% and 66.3%, respectively) of the total costs in the overall follow-up. Pembrolizumab introduction increased expenses but improved survival. Higher hospitalisation and emergency room occupation rates during follow-up reflected worsening clinical conditions of the negative/unknown group than the mutation-positive population.
本研究评估了免疫肿瘤（IO）方案作为一线（1L）治疗药物可及前后，转移性非小细胞肺癌患者的经济负担。根据基因突变状态，将2014年至2020年的患者分为突变阳性组与阴性/未知组，并依据帕博利珠单抗单药疗法在一线治疗中的可及性，进一步划分为1L IO前与1L IO后亚组。通过计算各组患者人均总费用及月均费用，报告了一线治疗期间及总体随访期间的医疗费用与医疗资源使用情况。在644例患者中，125例为突变阳性，519例为阴性/未知（其中1L IO前组229例，1L IO后组290例）。一线治疗阶段，突变阴性/未知组的人均总费用（1L IO前组7,804欧元，1L IO后组19,301欧元）低于突变阳性组（45,247欧元），这一差异在整个疾病随访期间持续存在。但按月均费用分析时，差异有所缩小。治疗费用是一线阶段的主要支出驱动因素，而随访期间住院费用显著上升。在突变阳性组与1L IO后组中，一线治疗费用分别占总随访费用的70.1%和66.3%，占比显著。帕博利珠单抗的引入虽增加了医疗支出，但改善了患者生存。随访期间，突变阴性/未知组较高的住院率与急诊占用率，反映出其临床状况较突变阳性组更差。
Healthcare Costs and Resource Utilisation of Italian Metastatic Non-Small Cell Lung Cancer Patients
肿瘤(癌症)患者之家