Health Care Resource Use, Clinical Management of Advanced NSCLC Vary By Country


Health care resource use (HCRU) and approaches to clinical management of advanced non-small cell lung cancer (NSCLC) vary significantly in eight different countries, according to a study published in BMC Health Services Research (online: March 1, 2018; doi:10.1186/s12913-018-2946-8).

Limited data exist regarding real-world HCRU for NSCLC. While NSCLC management recommendations and therapeutic options continue to evolve, a better understanding of current clinical practices and HCRU is needed.

Ashwini Arunachalam, Center for Observational and Real-World Evidence, Merck & Co (Kenilworth, NJ), and colleagues examined real-world HCRU for patients with advanced NSCLC. The study was conducted at academic and community oncology sites in Italy, Spain, Germany, Australia, Japan, South Korea, Taiwan, and Brazil.

The multinational, retrospective chart review study examined medical records of 1140 adults who initiated systematic therapy (2011 to mid-2013) for a new, confirmed diagnosis of advanced metastatic stage IIIB or IV NSCLC.  Researchers sought to summarize HCRU associated with first-line and subsequent lines of systemic therapy for advanced or metastatic NSCLC.

The results of the study showed the proportion of patients who were hospitalized at least once varied by country, from 24% in Italy to 81% in Japan during first-line therapy and from 22% in Italy to 84% in Japan during second-line therapy. Dependent on the country, overall hospitalization frequency was 2.5–11.1 per 100 patient-weeks.

Additionally, researchers found that emergency visit frequency also varied among countries (overall from 0.3–5.9 per 100 patient-weeks), increasing consistently from first- through third-line therapy in each country. The outpatient setting was found to be the most common setting of resource use. A majority of patients in the study had multiple outpatient visits in association with each line of therapy (overall from 21.1 to 59.0 outpatient visits per 100 patient-weeks, depending on country).


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Furthermore, researchers observed that HCRU showed no regular pattern associated with results of tests for activating mutations of the epidermal growth factor receptor (EGFR) gene or anaplastic lymphoma kinase (ALK) gene rearrangements.

Authors of the study concluded that HCRU varied by country, suggesting that approaches to the clinical management of advanced NSCLC differ internationally. “Comparative findings and an understanding of country-specific clinical practices can help to identify areas of need and guide future resource allocation for patients with advanced NSCLC,” they added.

Further studies are needed to assess the costs associated with resource use, researchers acknowledged.