(328) Healthcare resource utilization (HCRU) and costs during second-line (2L) treatment for small-cell lung cancer (SCLC)

Background: : SCLC accounts for 10%-15% of lung cancers and has poor prognosis; most patients (pts) relapse within < 6 months of first-line (1L) treatment (tx). Limited 2L tx options include chemotherapy which is often myelosuppressive and poorly tolerated and immuno-oncology (IO). A recent publication reported the mean total all-cause per-patient per month (PPPM) for 2L to be $21,446, reflecting the overall economic burden of SCLC.

Objective: : To report all-cause and myelosuppressive event (MYSPE)-related HCRU and associated costs among pts with SCLC during 2L tx.

Methods: : Pts from the Optum Market Clarity database had received 1L platinum-based chemotherapy (PBC) and initiated 2L tx for SCLC (index date) between 01 January 2020-31 May 2023, with continuous health insurance enrollment ≥6 months pre- and ≥1 month post-diagnosis. HCRU and costs were reported as PPPM to account for the variable follow-up. Lin’s regression analysis predicted 12-month costs comparing tx groups (adjusted for baseline characteristics and prior HCRU/costs).

Results: : 1063 pts received 2L tx: Zepzelca© (lurbinectedin) monotherapy (lurbi; n=350; 33%), PBC (n=249; 23%), topotecan-based (T; n=138; 13%), IO (alone or in combination; n=154; 14%), and others (n=172; 16%). Median age was 64 years; most pts were non-Hispanic and White. Median NCI Comorbidity Index score was similar across groups, but comorbidity profiles varied; pts in the lurbi group were older (median age: 65 years) with more metastatic sites (mean: 1.3). Mean all-cause ambulatory visits PPPM were similar across most groups. Other HCRU (ER visits, hospitalization) were low and comparable. The mean all-cause costs PPPM were $25,074 (PBC), $24,274 (lurbi), $24,069 (IO), and $17,762 (T). Predicted 12-month all-cause costs were highest for PBC ($249,914) vs IO ($220,258), lurbi ($168,975), and T ($121,865). Newly identified MYSPE (anemia, thrombocytopenia, pancytopenia, or neutropenia) were less frequent with IO (30%) and lurbi (41%) vs PBC (50%) and T (59%). Mean standard deviation (SD) MYSPE-related ambulatory visits PPPM were IO, 0.1 (0.5) lurbi, 0.2 (0.6); PBC, 0.3 (0.6); T, 0.4 (0.9). Mean (SD) MYSPE-related medical costs PPPM were lower for IO, $737 ($2595) and lurbi, $1407 ($4489) vs PBC, $1791 ($4999) and T, $2315 ($5033). Predicted 12-month costs for new MYSPE were IO ($6095); lurbi ($11,729); PBC ($12,111); T ($14,706).

Conclusions: : 2L lurbi monotherapy and IO are associated with less frequent MYSPE and potentially lower MYSPE-related HCRU and costs vs both PBC and T. Mean all-cause costs PPPM were lower for lurbi vs PBC and comparable to IO.

Sponsorship:: Jazz Pharmaceuticals