To assess the incremental cost associated with the management of patients with primary non-squamous non-small cell lung cancer (NSCLC) with brain metastases (BM) at the time of diagnosis
A retrospective database analysis was performed using the French exhaustive Hospital medical information database (PMSI). Patients with metastatic lung cancer were identified through a combination of ICD-10 diagnosis codes: C34* for lung cancer combined with at least one metastasis code (C77*, C78*, C79*). All such patients hospitalised with metastatic lung cancer for the first time in 2013 were eligible. Those with at least one prescription of bevacizumab or pemetrexed at the index stay or during the 24-month following period were considered to have non-squamous NSCLC. Two cohorts were identified, one with BM and one with metastases at other sites. For each patient, total in-hospital medical resource consumption associated with the initial stay in 2013 and with any follow-up stays in the following 24 months was documented. Costs were attributed from official French national tariffs and expressed in 2017 Euros.
The study included 1,529 patients with other metastases (62.6 ± 9.8 years old; 69.0% of men) and 971 patients with BM (58.6 ± 9.1 years old; 59.3% of men). The mean number of hospitalisations in the 24-month follow-up period was 17 per patient with other metastases and 21 per patient with BM. >99% of patients in both groups received chemotherapy. 57.7% patients with BM and 12.9% patients with other metastases were managed by radiotherapy. 37.2% patients with BM and 23.5% patients with other metastases received palliative care. 942 patients with other metastases and 695 with BM died during hospitalisation within two years (61.6% vs 71.6%). The associated cost was € 2,979 per patient-month for those with BM and € 2,426 for those with other metastases, representing a differential cost of € 553 per month. Radiotherapy (+€164/month) and palliative care (+€130/month) were the principal drivers of the incremental cost).
The presence of BM at the time of diagnosis of non-squamous NSCLC carries a significant burden, and ways of lowering it are needed.
Clinical trial identification
Legal entity responsible for the study
Roche SAS France.
N. Girard, A. Cortot: Member of advisory board for this project: Roche SAS. D. Cozzone: Employee: Roche SAS. L. de Léotoing, C. Tournier, A. Vainchtock: Employee: HEV, Roche SAS contracted with HEVA to conduct analyses on this project. B. Tehard: Employee: Roche SAS France.