Health care resource utilization (HCRU) and costs in insured patients with advanced lung cancer with or without clinical trial participation (CTP).

Abstract

e13526 Background: Clinical trials are often recommended for cancer treatment, but CTP remains low. CTP barriers may include higher costs to the patient or health plan. This study aimed to compare HCRU and costs for insured patients with advanced lung cancer with or without CTP. Methods: This retrospective cohort study used de-identified administrative claims data from commercial (COM) and Medicare Advantage (MA) enrollees in the Optum Labs Data Warehouse. Patients were identified in claims from 01/01/2018 to 02/28/2022 with ≥2 diagnoses ≥30 days apart for lung cancer, no other primary cancers, ≥1 advanced cancer diagnosis, ≥1 systemic therapy, and continuous enrollment in the 360-day baseline and follow-up ( < 360 if death) periods. Patients were categorized as “with CTP” (≥1 claim with ICD10 Z00.6 and ≥1 Q modifier claim ≥90 days after index claim) or “without CTP”. HCRU and costs (2022 US$) per patient per month (PPPM) were measured in the follow-up period. Total costs were adjusted for baseline characteristics using generalized linear models. Results: 8774 patients (15% COM, 85% MA) were identified: 274 with CTP, 8500 without CTP. Patients with CTP were more likely than patients without CTP to be treated at a comprehensive cancer center (COM 40% vs 27%, p = 0.03; MA 33% vs 14%, p < 0.001) and have baseline biomarker testing (COM 54% vs 35%, p = 0.002; MA 46% vs 34%, p < 0.001). Follow-up results (Table) showed similar hospital and emergency HCRU between the groups, but more frequent ambulatory visits for patients with CTP than without CTP. In COM plans, total and adjusted costs were lower with CTP vs without CTP. In MA plans, total costs were lower with CTP before adjustment and similar between groups after adjusting for baseline characteristics. Most costs (93-98%) were plan-paid, while 2-6% were patient-paid. Conclusions: Patients with CTP had more ambulatory visits but lower or similar total adjusted healthcare costs as patients without CTP in both populations. CTP did not appear to increase costs paid by the patient or health plan among this insured advanced lung cancer population. Follow-up HCRU and costs, mean (SD). COMWithout CTPN=1298 COMWith CTPN=57 P MAWithout CTP N=7202 MAWith CTPN=217 P HCRU, visit count PPPM  Inpatient 0.2 (0.7) 0.2 (0.3) 0.52 0.2 (0.5) 0.2 (0.4) 0.97  Emergency 0.2 (0.5) 0.2 (0.3) 0.53 0.2 (0.6) 0.2 (0.4) 0.12  Ambulatory 6.5 (4.9) 8.1 (4.8) 0.02 6.8 (5.1) 7.7 (4.4) 0.003 Health care costs, $ PPPM  Medical 22,418 (29,551) 18,327 (15,703) 0.07 10,384 (10,316) 8749 (9874) 0.02  Pharmacy 3236 (5856) 1447 (3769) 0.001 1284 (3615) 1121 (3527) 0.51  Total 25,653 (29,014) 19,774 (15,928) 0.01 11,668 (10,620) 9869 (10,441) 0.01  Total adjusted* 27,040 18,792 0.02 12,539 14,074 0.10 *Adjusted for age, sex, index year, region, treatment center type, baseline days from advanced cancer diagnosis, comorbidities, costs, use of biomarker tests, radiation, and systemic therapy.