Abstract 441P
Background
About 20%–40% of advanced Non-Small Cell Lung Cancer (NSCLC) cases have treatable EGFR mutations (mEGFR). In low- and middle-income countries, high costs and limited availability of EGFR Tyrosine Kinase Inhibitors (TKIs) restrict access. Out-of-pocket expenses (OOPE), often uncovered by insurance, impact treatment adherence and outcomes. In India, OOPE dropped from 64.2% in 2013 to 39.4% in 2021 due to better healthcare funding and affordable generics. This study examines how OOPE affects treatment compliance in patients on EGFR TKIs.
Methods
This study followed patients with advanced mEGFR NSCLC on first-generation (1G) EGFR TKIs for three months under a government insurance scheme covering diagnostics, treatment, and some travel costs. Data on demographics, treatment, and OOPE were collected through patient interviews. Adherence was assessed using the medication possession ratio.
Results
Out of 157 cases with mEGFR advanced NSCLC, 113 were eligible for OOPE analysis while on 1G EGFR TKIs. The median age was 46 years, with females making up 56.6%. Common EGFR mutations were seen in 95% of cases (Del 19 in 68%, L858R in 27%). Due to financial constraints, 92.3% were tested for EGFR by PCR instead of a comprehensive gene panel. Gefitinib was the most frequently used TKI 85.8%, followed by Erlotinib 14.2%. Most patients were illiterate 61.9%, with only 30.8% having completed school and 7% holding a graduate or higher degree. Nearly half 48.6% were unemployed and dependent, while 39.8% were self-employed. Majority 97.3% had an annual income below 1 lakh ($ 1,165). Monthly OOPE averaged $ 44 for out-of-state and $ 20 for in-state patients. TKI adherence was high, 94.5% and discontinuation rates were 4.4%.
Conclusions
Out-of-pocket expenses (OOPE) can create a significant financial burden, affecting treatment compliance and outcomes. Our study revealed that there are considerable OOPE not covered by state insurance. Interestingly, TKI adherence was high and discontinuation rates were low. However,we recommend revision of insurance policies to include OOPE particularly for low-income groups. Our plan is to expand the study, include financial toxicity due to loss of wage and conducting longer follow-up to assess the impact of OOPE on overall survival.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.