表皮生长因子受体（EGFR）突变的晚期或转移性非小细胞肺癌患者的医疗资源使用、医疗成本及未满足的需求
Healthcare Resource Use, Healthcare Costs, and Unmet Needs Among Patients Treated for EGFR-Mutated Advanced or Metastatic Non-small Cell Lung Cancer.
作者信息
Waterhouse David, Li Iris, Morrison Laura, Emond Bruno, Lafeuille Marie-Hélène, Hilts Annalise, Korsiak Jill, Lefebvre Patrick, Vadagam Pratyusha, Waters Dexter
机构信息
OHC (Oncology-Hematology Care), Cincinnati, Ohio.
Johnson & Johnson, Horsham, Pennsylvania.
出版信息
J Health Econ Outcomes Res. 2025 Aug 29;12(2):98-107. doi: 10.36469/001c.142771. eCollection 2025.
BACKGROUND
Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor-mutated (EGFRm) NSCLC, 84% of which are exon 19 deletions (Ex19del)/exon 21 substitutions (L858R). Unmet needs for patients treated with tyrosine kinase inhibitors (TKIs) for EGFRm (Ex19del/L858R) advanced NSCLC, including osimertinib, are relevant to US population health decision makers.
OBJECTIVES
To describe healthcare resource utilization (HRU) and costs by line of therapy (LOT) among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating first-line (1L) treatment.
METHODS
IBM MarketScan® Research Databases (1/1/2010-1/31/2023) were used to select adult patients with advanced NSCLC initiating an EGFR-TKI during any LOT on/after 4/18/2018 (osimertinib approval; EGFRm Ex19del/L858R proxy). Per-patient-per-month (PPPM) all-cause HRU and costs were described in 1L, second-line (2L), and third-line (3L) overall and among subgroups receiving 1L osimertinib monotherapy or platinum-based chemotherapy (PBC) without immunotherapy, separately.
RESULTS
The study included 409 patients with EGFRm advanced NSCLC (mean age, 60.5 years; 70.2% female). In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of >4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). Mean all-cause costs PPPM were 28 971 in 2L, and 27 610 in 1L, 36 618 in 3L. Among the 1L PBC subgroup (n = 58), mean PPPM costs were 24 788 in 2L, and $23 348 in 3L.
DISCUSSION
Among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating 1L, each successive LOT was shorter and more costly.
CONCLUSIONS
Findings highlight the importance of using the most effective 1L treatments to delay disease progression and reduce HRU and costs.
背景
约17%的非小细胞肺癌（NSCLC）患者患有表皮生长因子受体突变（EGFRm）的NSCLC，其中84%为外显子19缺失（Ex19del）/外显子21置换（L858R）。对于接受酪氨酸激酶抑制剂（TKIs）治疗的EGFRm（Ex19del/L858R）晚期NSCLC患者，包括奥希替尼，未满足的需求与美国人群健康决策者相关。
目的
描述启动一线（1L）治疗的EGFRm（Ex19del/L858R）晚期NSCLC患者按治疗线数（LOT）划分的医疗资源利用（HRU）和成本。
方法
使用IBM MarketScan®研究数据库（2010年1月1日至2023年1月31日）选择在2018年4月18日及之后的任何治疗线中开始使用EGFR-TKI的晚期NSCLC成年患者（奥希替尼获批；EGFRm Ex19del/L858R替代指标）。分别描述了1L、二线（2L）和三线（3L）总体以及接受1L奥希替尼单药治疗或不含免疫治疗的铂类化疗（PBC）的亚组中每位患者每月（PPPM）的全因HRU和成本。
结果
该研究纳入了409例EGFRm晚期NSCLC患者（平均年龄60.5岁；70.2%为女性）。在1L中，72.9%开始基于奥希替尼的治疗（2L为45.9%；3L为41.2%），21.0%开始化疗（2L为30.0%；3L为36.5%），4.6%开始使用另一种EGFR-TKI（2L为12.9%；3L为12.9%），1.5%开始免疫治疗（2L为11.2%；3L为9.4%）。总体而言，170例患者（41.6%）进展至2L，其中85例（50.0%）进展至3L。平均治疗线持续时间随着每一个连续的治疗线而缩短（1L为10.2个月；2L为8.7个月；3L为8.0个月）。在各治疗线中，患者平均每月门诊就诊次数>4次（1L为4.79次；2L为4.26次；3L为4.40次），1L奥希替尼单药治疗亚组（n = 279）在1L期间平均每月住院天数为0.69天（2L为0.82天；3L为0.74天）。平均全因成本PPPM在2L为28971美元，在1L为27610美元，在3L为36618美元。在1L PBC亚组（n = 58）中，2L的平均PPPM成本为24788美元，3L为23348美元。
讨论
在启动1L治疗的EGFRm（Ex19del/L858R）晚期NSCLC患者中，每一个连续的治疗线都更短且成本更高。
结论
研究结果突出了使用最有效的1L治疗来延缓疾病进展以及降低HRU和成本的重要性。
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