Economic burden of advanced non-small cell lung cancer (NSCLC): a systematic literature review.

[AIMS] A systematic review of the economic burden of advanced non-small-cell lung cancer (NSCLC).

[METHODS] Articles from 2011 onwards reporting the economic burden of locally advanced (stage IIIB/C)/metastatic (stage IV) NSCLC were identified through systematic and supplementary searches. Outcomes included hospitalizations, emergency department (ED) and outpatient visits, and direct and indirect costs, amongst others.

[RESULTS] Across 50 publications (43 studies), patients with advanced NSCLC had high rates of healthcare resource utilization (HCRU), with most reporting hospitalization (ranging from 13.0% to 98.2% of patients), ED visits (2.5% to 83.1%), outpatient visits (74.6% to 100.0%), and diagnostic or monitoring tests (45.9% to 92.0%). HCRU (hospitalizations, ED visits and pharmacy visits) appeared to be lower with immunotherapy as compared to chemotherapy. Brain/central nervous system (CNS) metastases were the major clinical factor influencing HCRU. Mean direct costs ranged from US$5,647 (Brazil) to US$158,908 (US) over 12-24 months, and were generally higher in the US, Korea, Germany, and the UK (vs. Brazil, France, and Italy). The main direct cost drivers were drug-related costs (9.5-76.0% of total), overall outpatient costs (39-70.6%), and inpatient costs (5.0-58.1%). Costs were higher for chemotherapy than for immunotherapy. In China, indirect medical costs were US$1,413 per case. In general, mean total healthcare costs were higher for metastatic disease. Disease severity/diagnosis, presence of brain/CNS metastases, targeted therapy and chemotherapy (vs. immunotherapy) and the presence of comorbidities were the main factors influencing higher costs.

[LIMITATIONS AND CONCLUSIONS] Patients with advanced NSCLC had high rates of HCRU, and costs were substantial, though varying greatly across countries. HCRU and costs were higher in patients with brain/CNS metastases. Since this was a qualitative review, no formal quantitative synthesis was attempted. Costs reported in different currencies and heterogeneity across studies limited comparability. Finally, a single reviewer extracted data.