Abstract
Background/Aims Research has demonstrated that platinum-based chemotherapy may prolong short-term survival and improve symptom control in patients with advanced (stage IIIb-IV) non-small cell lung cancer (NSCLC). Newer chemotherapy agents (e.g., taxanes, antimetabolites, monoclonal antibodies, drugs targeting EGFRs), used as singlet, doublet, or triplet regimens, may improve survival. However, these agents are expensive and may produce side effects requiring hospitalization. Little is known regarding variation in both use (singlet vs. doublet vs. triplet regimens) and outcomes (survival, hospitalizations, cost) in community practices over time for non-aged populations, adjusting for comorbidities.
Aims Using information from the HMO Cancer Research Network’s (CRN) Virtual Data Warehouse (VDW), we examined the impact on variation over time in use of first-line chemotherapy regimens (singlet vs. doublet vs. triplet) in stage lIIb-IV NSCLC patients on survival, hospitalizations, and costs.
Methods Patients aged less than 21 years with stage IIIb-IV NSCLC diagnosed between 2000–2007 at four CRN sites were included in the analysis. Patients were followed from diagnosis date through 2008 (or death or disenrollment). Patient demographics, comorbidities, chemotherapy treatment data, and mortality were obtained from the CRN VDW. Propensity-adjusted survival and Poisson modeling were employed to examine variation in survival days and hospitalizations. Average wholesale price data were used to examine the relative difference in costs by chemotherapy regimen.
Results We identified 3,072 stage lIIb-IV NSCLC patients who received first-line chemotherapy of which 24% were <65 years old at diagnosis. The distribution of first-line therapy changed significantly over time with the introduction of taxane, monoclonal antibody, and antimetabolite agents in the later years of the study period. Those receiving singlet regimens were older and had more comorbidities. Unadjusted survival rates were higher for those receiving triplet therapy, but only against singlet regimens in adjusted models. Those receiving singlet regimens had the greatest number of hospitalizations. The costs of doublet and triplet regimens were significantly higher than the singlet regimens.
Discussion There was significant variation over time in chemotherapy regimens used in the CRN. Triplet therapy appeared to be associated with the best outcomes and fewest side effects. However, cost considerations for triplet therapy warrant assessments of their cost-effectiveness.
