528P - Socioeconomic determinants of access to standard-of-care treatments in advanced and metastatic NSCLC in Hong Kong: A territory-wide study

Background

Precision medicine has been increasingly practiced to select best-fit systemic treatment for advanced and metastatic (a/m) NSCLC. Though new treatment options help improve survival outcomes, they have led to increased financial burdens. In Hong Kong, limited financial assistance programs place the majority of treatment cost on patients. Our study aims to identify gaps in accessing standard-of-care (SOC) treatments and its determinants.

Methods

This prospective, territory-wide cohort study enrolled newly diagnosed a/m NSCLC patients from seven public oncology centers in Hong Kong since Mar 2021. Data on genomic landscape, treatment patterns and socioeconomic status (SES) of NSCLC patients were collected. Provision of SES data was voluntary. Patients were dichotomized into with or without druggable mutations. Proportion of patients receiving SOC were reported and analyzed in relation with SES parameters.

Results

Among 350 patients with SES data, 194 (55.5%) paid out-of-pocket costs for treatments, 110 (31.5%) were partially reimbursed by means-tested subsidy and 34 (9.7%) were fully reimbursed in employee remuneration package. Household income (HI) of 215 patients (60.9%) is less than 23000 USD/year, 95 (26.9%) between 23001-55300 USD/year, and 43 (12.1%) above 55301 USD/year. About 50% of patients had at least 2 children, lived with family members and received secondary education or above. For patients with druggable mutation (n=259), 152 (58.7%) received corresponding targeted treatments. In multivariate analyses (MVA), patients with HI >= 23001 USD/yr is significantly more likely to follow SOC than those with lower income. Self-financed patients are significantly more likely to receive targeted therapies than those with subsidy (OR: 3.73, p=0.004). For patients without druggable mutation (n=77), 32 (52%) received immunotherapy alone or combination. In MVA, patients with HI above 55301 USD/year are more likely to receive immunotherapy as part of treatment than those with lower income (OR: 11.90, p=0.08).

Conclusions

Patients with HI below 55301 USD/year is at risk of deprivation to accessing SOC treatment. Societal efforts are needed to secure equitable access to cancer treatment to all.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The University of Hong Kong.

Funding

Innovation and Technology Commission (HKSAR) & Roche.

Disclosure

All authors have declared no conflicts of interest.