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. 2018 Sep 8;3(6):e000414.
doi: 10.1136/esmoopen-2018-000414. eCollection 2018.

Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

Nicolas Girard  1   2 , Delphine Cozzone  3 , Lucie de Leotoing  4 , Charlène Tournier  4 , Alexandre Vainchtock  4 , Bertrand Tehard  3 , Alexis B Cortot  5
Affiliations

Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

Nicolas Girard et al. ESMO Open. .

Abstract

Purpose: To assess the incremental cost associated with the management of patients with primary non-squamous non-small cell lung cancer (NSCLC) with brain metastases at the time of diagnosis.

Methods: Data were extracted from the French Hospital medical information database (Programme de Médicalisation des Systèmes d'Information (PMSI)). Patients with non-squamous NSCLC were identified through a diagnosis of lung cancer and a prescription of bevacizumab or pemetrexed. All such patients hospitalised with lung cancer for the first time in 2013 and with metastases identified at the first hospitalisation were eligible. Two cohorts were identified, one with brain metastases (group B: n=971) and one with metastases at other sites (group A: n=1529). For each patient, total in-hospital medical resource consumption associated with the initial hospitalisation in 2013 and with any follow-up stays in the following 24 months was documented. Costs were attributed from official French national tariffs and expressed in 2017 euros.

Results: The mean number of hospitalisations per patient in the 24-moth follow-up period was 17 in group A and 21 in group B. >99% of patients in both groups received chemotherapy. 58% of patients in group B and 13% in group A were managed by radiotherapy. 37% in group B and 24% in group A received palliative care. The associated cost was €2979 per patient-month for patients in group B and €2426 for patients in group A, representing a differential cost of €553 per month. Radiotherapy (+€164/month) and palliative care (+€130/month) were the principal drivers of the incremental cost.

Conclusions: The presence of brain metastases at the time of diagnosis of non-squamous NSCLC carries a significant burden, and ways of lowering this burden are needed.

Keywords: PMSI; anaplastic lymphoma kinase.; brain metastasis; cost; non-squamous non-small cell lung cancer; radiotherapy.

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Conflict of interest statement

Competing interests: NG has received personal fees from Roche, AstraZeneca, Pfizer, BMS, MSD and Novartis, in addition to being an investigator in trials involving these companies; relationships include consultancy service and membership of scientific advisory boards. DC and BT are employees of Roche. LdL, CT and AV have received grants via their company from Roche. ABC has received personal fees from AstraZeneca, Roche, Pfizer, Novartis, MSD, BMS and Takeda, grants from Novartis and Merck, and disclose collaborations with AstraZeneca, Roche, Boehringer-Ingelheim, BMS, MSD, Merck, Novartis and Pfizer.

Figures

Figure 1
Figure 1
Flow diagram for the selection of the study population. BM, brain metastasis; NSCLC, non-small cell lung cancer.
Figure 2
Figure 2
Evolution of mean cost per patient for each month of follow-up in patients with non-squamous non-small cell lung cancer (NSCLC) in 2013–2014 (National Health Insurance (NHI) perspective).
See this image and copyright information in PMC

Comment in

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