Non-Small Cell Lung Cancer Coverage from Every Angle

Quality Care 2019: Out-of-Pocket Costs of Oral Agents and Outcomes in Advanced Lung Cancer

By: Susan Reckling
Posted: Friday, September 6, 2019

Based on the findings of a study of more than 100 patients treated with oral tyrosine kinase inhibitors (TKIs) for advanced non–small cell lung cancer (NSCLC), the out-of-pocket costs of these agents seemed to be linked to a lower number of prescriptions and shorter duration of therapy. Also impacted by these costs were survival, which was found to be poorer in these patients. Bernardo H.L. Goulart, MD, MS, of Fred Hutchinson Cancer Research Center in Seattle, and colleagues will be presenting these findings at the 2019 American Society of Clinical Oncology (ASCO) Quality Care Symposium in San Diego (Abstract 3).

“Patients paying the highest out-of-pocket costs for TKIs have a greater risk of death,” stated Dr. Goulart in an ASCO press release “If we can confirm the results with a larger nationwide sample, the findings help to make the case for a review of Medicare coverage for these effective medications.”

A total of 106 patients with stage IV NSCLC (73% of whom were white) were identified form the Washington State Surveillance, Epidemiology, and End Results registry. These patients, who had EGFR and ALK mutations, had to have at least one prescription for an oral TKI. The median out-of-pocket costs for these medications were calculated for the first 3 months of therapy and estimated by subtracting the amount paid from the amount allowed in pharmacy claims.

In a multivariate analysis, the investigators reported that the quarter of patients with the highest median out-of-pocket costs were more than twice as likely to die after 3 months of starting TKI treatment compared with all other patients in the study (adjusted hazard ratio = 2.31, P = .003). The researchers are planning to conduct a larger nationally representative sample to confirm these study results.

Disclosure: The study authors’ disclosure information may be found at

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