Economic Burden and Provider Referral Patterns Among Patients with Unresectable Stage III EGFR-Mutated NSCLC Receiving Chemoradiotherapy in the United States

Abstract

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. Chemotherapy followed by radiotherapy, known as chemoradiotherapy (CRT), is recommended as the most appropriate treatment for patients with unresectable (inoperable) stage III non-small cell lung cancer (NSCLC). In the USA, 10–15% of patients with unresectable stage III NSCLC have tumors that contain a mutation in the epidermal growth factor receptor gene (known as EGFRm NSCLC). EGFR is a protein that controls cell growth and division. Osimertinib has emerged as a promising new treatment for patients with EGFRm, but little is known about their needs and course of treatment. Our study assessed the economic burden, provider referral patterns, and mutation testing patterns associated with treatment in the era prior to osimertinib’s approval. We used insurance claims and electronic health records to identify 144 patients with EGFRm and unresectable stage III NSCLC. After initiating CRT, costs averaged $28,020 per patient per month, mostly attributable to ambulatory (office/outpatient) visits (49.0% of total costs) and medications (15.1%). Between NSCLC diagnosis and CRT initiation, patients most frequently visited oncology/hematology specialists (seen by 67.4% of patients). Suggestive of a multidisciplinary team of providers, 13 patients (9.0%) had same-day consultations with multiple specialties before CRT initiation. The median time to CRT initiation from diagnosis was 11 days earlier than patients who saw three or more specialists in sequential order. Although all patients had EGFRm, only 76.4% of testing claims occurred before CRT initiation. To improve patient care and treatment access, multidisciplinary provider consultations and EGFR testing prior to CRT initiation are encouraged.