Costs of First-Line Doublet Chemotherapy and Lifetime Medical Care in Advanced Non–small-Cell Lung Cancer in the United States

ObjectivesThe purpose of this study was to identify total lifetime medical-care costs and costs associated with first-line chemotherapy treatment among older patients with stage IIIB/IV non–small-cell lung cancer treated with commonly used two-drug chemotherapy (“doublet”) regimens in the United States.MethodsStudy patients included individuals aged 65 years and older who received a diagnosis of stage IIIB/IV non–small-cell lung cancer in a Surveillance, Epidemiology and End Results cancer registry between 1997 and 2002 and who received first-line treatment with commonly used doublet regimens. Patients were followed retrospectively in the Surveillance, Epidemiology and End Results—Medicare database to evaluate lifetime medical-care costs and costs while on first-line chemotherapy treatment. Pairwise comparisons of treatment costs were estimated by using nonparametric bootstrap methods.ResultsLifetime medical-care costs totaled approximately $70,000 and on-treatment costs for first-line chemotherapy totaled approximately $30,000 among study patients and were dominated by hospitalization and physician costs. Lifetime costs were significantly higher among patients treated with first-line cisplatin/carboplatin (platinum) plus a taxane compared with those who received platinum plus gemcitabine [difference: $4781 ($1558–$8039)] or other doublet therapy [difference: $5961 ($2333–$9614)]. Total on-treatment costs for first-line chemotherapy were significantly higher among patients treated with platinum plus a taxane compared with those who received platinum plus gemcitabine [difference: $5825 ($3872–$7770)], platinum plus another agent [difference: $5968 ($3995–$7975)], or another doublet therapy [difference: $3663 ($1620–$5740)].ConclusionsThere is a cost differential between first-line doublet regimens in terms of lifetime and on-treatment costs. Although doublet therapy with platinum and a taxane was the most frequently utilized regimen, it was associated with the highest lifetime and on-treatment costs.