Kim YongJin, Zhu Yong, Moore Kristin J, DuCharme Mary, James Dan, Shehu Arber, Rattigan-Brown Yanique, Ohaegbulam Kim
AstraZeneca, Mississauga, ON, Canada.
Optum, 1 Optum Circle, Eden Prairie, MN, 55344, USA.
Adv Ther. 2025 May 29. doi: 10.1007/s12325-025-03239-y.
Among patients with unresectable stage III non-small cell lung cancer (NSCLC), those whose tumors harbor epidermal growth factor receptor mutations (EGFRm) are associated with comparatively fewer treatment options and worse prognosis. With the recent approval of targeted treatment, characterizing the economic burden and EGFRm testing and provider referral patterns is crucial to understanding the unmet needs of these patients.
This was a retrospective analysis of Optum's Market Clarity Dataset from January 1, 2018 to June 30, 2023. Eligibility criteria included diagnosis with unresectable stage III EGFRm NSCLC and chemoradiotherapy (CRT) initiation (index date) within 90 days. Primary outcomes were per patient per month (PPPM) all-cause and NSCLC-related health care resource utilization (HCRU) and costs, and EGFRm testing and provider referral patterns.
A total of 144 patients were followed for a median of 15.5 months; 56.3% of patients underwent EGFRm testing before CRT initiation. All-cause and NSCLC-related costs during follow-up were $28,020 and $22,816 PPPM, respectively. Ambulatory utilization was the major driver of this economic burden. Pharmacy costs accounted for $4244 (15.1%) and $3736 (16.4%) of the total all-cause and NSCLC-related costs, respectively. Between diagnosis and CRT initiation, the most common specialties visited were oncology/hematology (seen by 67.4% of patients), radiology (26.4%), pulmonology (22.2%), and cardiology (21.5%). Patients who visited three or more specialties on separate days before CRT initiation had a median time to CRT initiation of 33.0 days versus 22.0 days when patients visited multiple specialties on the same day (suggestive of a multidisciplinary care team, MDT).
Patients with unresectable stage III EGFRm NSCLC incur substantial economic burden, especially in ambulatory HCRU and costs. With the recent approval of targeted treatment for these patients, reflex EGFRm testing in all early-stage NSCLC at diagnosis is encouraged. Our results also suggest MDT involvement may improve completeness in diagnosis and staging, resulting in acceleration of treatment planning and management.
在不可切除的III期非小细胞肺癌（NSCLC）患者中，肿瘤携带表皮生长因子受体突变（EGFRm）的患者治疗选择相对较少，预后较差。随着靶向治疗的近期获批，了解这些患者的经济负担、EGFRm检测情况以及医疗服务提供者的转诊模式对于明确其未满足的需求至关重要。
这是一项对Optum公司市场透明度数据集进行的回顾性分析，时间跨度为2018年1月1日至2023年6月30日。纳入标准包括诊断为不可切除的III期EGFRm NSCLC且在90天内开始放化疗（CRT，索引日期）。主要结局指标为每位患者每月（PPPM）的全因及NSCLC相关的医疗保健资源利用（HCRU）和费用，以及EGFRm检测情况和医疗服务提供者的转诊模式。
共对144例患者进行了中位时间为15.5个月的随访；56.3%的患者在开始CRT前进行了EGFRm检测。随访期间的全因和NSCLC相关费用分别为每位患者每月28,020美元和22,816美元。门诊利用是这一经济负担的主要驱动因素。药房费用分别占全因和NSCLC相关总费用的4244美元（15.1%）和3736美元（16.4%）。在诊断至开始CRT期间，就诊最多的专科是肿瘤学/血液学（67.4%的患者就诊）、放射学（26.4%）、肺病学（22.2%）和心脏病学（21.5%）。在开始CRT前在不同日期就诊三个或更多专科的患者开始CRT的中位时间为33.0天，而在同一天就诊多个专科的患者为22.0天（提示多学科护理团队，MDT）。
不可切除的III期EGFRm NSCLC患者承受着巨大的经济负担，尤其是在门诊HCRU和费用方面。鉴于这些患者的靶向治疗近期获批，鼓励对所有早期NSCLC患者在诊断时进行EGFRm检测。我们的结果还表明，多学科护理团队的参与可能会提高诊断和分期的完整性，从而加快治疗计划和管理的进程。
