Economic Burden and Provider Referral Patterns Among Patients with Unresectable Stage III EGFR-Mutated NSCLC Receiving Chemoradiotherapy in the United States
Notice bibliographique
Résumé
Among patients with unresectable stage III non-small cell lung cancer (NSCLC), those whose tumors harbor epidermal growth factor receptor mutations (EGFRm) are associated with comparatively fewer treatment options and worse prognosis. With the recent approval of targeted treatment, characterizing the economic burden and EGFRm testing and provider referral patterns is crucial to understanding the unmet needs of these patients. This was a retrospective analysis of Optum’s Market Clarity Dataset from January 1, 2018 to June 30, 2023. Eligibility criteria included diagnosis with unresectable stage III EGFRm NSCLC and chemoradiotherapy (CRT) initiation (index date) within 90 days. Primary outcomes were per patient per month (PPPM) all-cause and NSCLC-related health care resource utilization (HCRU) and costs, and EGFRm testing and provider referral patterns. A total of 144 patients were followed for a median of 15.5 months; 56.3% of patients underwent EGFRm testing before CRT initiation. All-cause and NSCLC-related costs during follow-up were $28,020 and $22,816 PPPM, respectively. Ambulatory utilization was the major driver of this economic burden. Pharmacy costs accounted for $4244 (15.1%) and $3736 (16.4%) of the total all-cause and NSCLC-related costs, respectively. Between diagnosis and CRT initiation, the most common specialties visited were oncology/hematology (seen by 67.4% of patients), radiology (26.4%), pulmonology (22.2%), and cardiology (21.5%). Patients who visited three or more specialties on separate days before CRT initiation had a median time to CRT initiation of 33.0 days versus 22.0 days when patients visited multiple specialties on the same day (suggestive of a multidisciplinary care team, MDT). Patients with unresectable stage III EGFRm NSCLC incur substantial economic burden, especially in ambulatory HCRU and costs. With the recent approval of targeted treatment for these patients, reflex EGFRm testing in all early-stage NSCLC at diagnosis is encouraged. Our results also suggest MDT involvement may improve completeness in diagnosis and staging, resulting in acceleration of treatment planning and management. Chemotherapy followed by radiotherapy, known as chemoradiotherapy (CRT), is recommended as the most appropriate treatment for patients with unresectable (inoperable) stage III non-small cell lung cancer (NSCLC). In the USA, 10–15% of patients with unresectable stage III NSCLC have tumors that contain a mutation in the epidermal growth factor receptor gene (known as EGFRm NSCLC). EGFR is a protein that controls cell growth and division. Osimertinib has emerged as a promising new treatment for patients with EGFRm, but little is known about their needs and course of treatment. Our study assessed the economic burden, provider referral patterns, and mutation testing patterns associated with treatment in the era prior to osimertinib’s approval. We used insurance claims and electronic health records to identify 144 patients with EGFRm and unresectable stage III NSCLC. After initiating CRT, costs averaged $28,020 per patient per month, mostly attributable to ambulatory (office/outpatient) visits (49.0% of total costs) and medications (15.1%). Between NSCLC diagnosis and CRT initiation, patients most frequently visited oncology/hematology specialists (seen by 67.4% of patients). Suggestive of a multidisciplinary team of providers, 13 patients (9.0%) had same-day consultations with multiple specialties before CRT initiation. The median time to CRT initiation from diagnosis was 11 days earlier than patients who saw three or more specialists in sequential order. Although all patients had EGFRm, only 76.4% of testing claims occurred before CRT initiation. To improve patient care and treatment access, multidisciplinary provider consultations and EGFR testing prior to CRT initiation are encouraged.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».