Treatment landscape in metastatic lung cancer is quickly evolving and is associated with improved survival but also increased costs. However, epidemiological data on the survival and costs of patients at metastatic stage are limited. This study aimed to describe change in epidemiological data and costs of these patients between 2013 and 2021. From the French national claims database (SNDS), a dynamic cohort of patients identified between 2013 and 2021 with metastatic lung cancer and a marker for the presence of metastases (ICD-10 code or at least one reimbursement for Bevacizumab or Pemetrexed) was constituted. A patient was considered as newly diagnosed if no other marker of the presence of metastases were identified in the 7 years prior to inclusion in the cohort. A trend analysis of the rate of newly diagnosed metastatic patients, the proportion of deaths and the mean monthly cost per patient over the period 2013-2021 was performed using Joinpoint software. 147,760 metastatic lung cancer patients were identified between 2013 and 2021: 66.5% of men, with a median age of 66 years. Between 2013 and 2021, a statistically significant decrease in the crude rate of newly diagnosed metastatic patients was highlighted in men (-1.18% per year in average), whereas a statistically significant increase was described in women (+2.36% per year in average). A statistically significant decrease in the proportion of deaths was described for both men and women (-4.37% and -5.07% per year on average, respectively). The mean monthly cost per patient decreased from 2013 to 2015 (from 5,685€ to 4,790€), by 8.90% per year (95%CI: -15.67 to -1.59), then stabilized (1.35%; 95%CI: -0.12 to 2.84). This study provides unpublished epidemiological data on metastatic lung cancer in France and confirms differentiated trends in the number of newly diagnosed metastatic patients in men and women, already observed for all stages combined. A statistically significant decrease in the proportion of deaths among metastatic lung cancer patients is observed in both gender over the study period. The mean monthly cost per patient initially decreased, then stabilized between 2015 and 2021.

Treatment landscape in metastatic lung cancer is quickly evolving, including targeted therapies and immunotherapies. Both treatments have shown improved survival but are also associated with increased costs. This study aimed to describe the evolution of costs associated with metastatic lung cancer in France. From the French national claims database (SNDS), a dynamic cohort of patients identified between 2013 and 2019 with metastatic lung cancer and a marker for the presence of metastases (ICD-10 code or at least one reimbursement for Bevacizumab or Pemetrexed) was constituted. Healthcare resource use was described each calendar year through the percentage of patients with at least one record for each expenditure item. The associated costs were reported monthly and estimated from the health insurance perspective. The trend over the study period for the total mean monthly cost was studied using Joinpoint software. Between 2013 and 2019, 116 686 patients with a metastatic lung cancer were identified (67.1% of men, median age of 65 years). The percentage of patients with at least one overnight hospitalization decreased from 85.2% in 2013 to 67.6% in 2019 while the use of day hospitalizations remained stable (about 40%). The percentage of patients with outpatient care increased over the study period: medical visits (from 82.6% to 88.0%), lab tests (from 74.1% to 83.5%), medical procedures (from 72.0% to 83.2%). The total mean monthly cost per patient decreased between 2013 and 2019 (from 5,683€ to 4,653€), by 2.85% per year (95%CI: -4.13 to -1.56, p<0.0001). An increase in drugs acquisition costs (from 1,015€ to 1,365€) and a decrease in the cost of overnight hospitalizations (from 3,110€ to 1,990€) were observed. This study highlights that the increase in drugs acquisition costs has been offset by a decrease in hospitalization costs, resulting in a decrease in global management costs of patients with metastatic lung cancer in France between 2013 and 2019. These findings may be the result of French health policy and may also be related to improved disease management.

Pour le cancer du poumon métastatique, l’offre thérapeutique évolue rapidement, incluant notamment des thérapies ciblées et des immunothérapies, et est associée dans de nombreux essais cliniques à une meilleure survie. Cependant, les données épidémiologiques sur l’évolution de la survie des patients à un stade métastatique sont rares. Cette étude a donc eu pour objectif de les identifier et de les caractériser. À partir des données du Système National des Données de Santé (SNDS), une cohorte dynamique de patients identifiés entre 2013 et 2019 comme ayant un cancer du poumon et un élément caractéristique de présence de métastases (code CIM-10 ou au moins un remboursement de Bevacizumab ou Pemetrexed) a été analysée. Un patient a été considéré comme nouvellement diagnostiqué métastatique si aucun autre élément caractéristique de la présence de métastases n’était identifié dans les 7 ans avant son entrée dans la cohorte. Une analyse de tendance du taux de patients nouvellement diagnostiqués métastatiques et de la proportion de décès sur la période 2013–2019 a été réalisée à l’aide du logiciel Joinpoint. 116 686 patients avec un cancer du poumon métastatique ont été identifiés entre 2013 et 2019: majoritairement des hommes (67,1%), avec un âge médian de 65 ans et souffrant de comorbidités multiples (54,6% avec une pathologie cardiovasculaire, 27,6% avec une insuffisance respiratoire chronique, 16,3% avec un diabète). D’après les tests de tendance entre 2013 et 2019, le nombre de patients nouvellement diagnostiqués métastatiques a diminué significativement chez les hommes (-1,8% par an en moyenne), passant de 32,1 à 28,7/100 000 habitants. À l’inverse, ce chiffre a augmenté significativement chez les femmes (+2,4% par an en moyenne), passant de 13,0 à 15,2/100 000 habitants. Le pourcentage de décès est significativement en diminution entre 2013 et 2019 chez les hommes et chez les femmes (−4,7% et −5,1% par an en moyenne, respectivement). Cette étude fournit des données épidémiologiques inédites sur le cancer du poumon métastatique et confirme des tendances différenciées sur le nombre de patients nouvellement diagnostiqués métastatiques chez les hommes et les femmes, déjà observées tous stades confondus. Une diminution significative et constante du pourcentage de décès chez les patients diagnostiqués métastatiques est observée à la fois chez les hommes et les femmes sur la période de l’étude.

To assess health care resource use (HCRU) and associated costs of patients with spinal muscular atrophy (SMA), a rare genetic disease characterized by weakness and progressive muscular atrophy caused by motor neuron degeneration, in France. A retrospective cohort study using data from the national French health insurance database (SNDS) was conducted. All patients with SMA recorded between 2014 and 2018 were included and classified according to SMA type (Type 1 [SMA1] or Types 2–4 [SMA2+]) using algorithms. HCRU and associated costs were described per month, by SMA type and by age. End-of-life costs were described in the three and six months before death in patients with SMA1 and SMA2+, respectively. We identified 934 patients with SMA, 307 (32.9%) classified as SMA1 (median age: 8 months; 54.1% male) and 627 (67.1%) classified as SMA2+ (median age: 17 years; 56.6% male). Most patients (96.5%) experienced at least one hospitalization. The overall mean number of medical contacts was 8 per month, of which ∼60% were visits to physiotherapists. Average monthly costs from a collective perspective were €11,854 and €5,344 per month for patients with SMA1 and SMA2+, respectively, with 63.8% and 71.4% related to nusinersen injection costs, respectively. The remaining costs (€4,297 [SMA1] and €1,530 [SMA2+]) were mainly driven by hospitalizations and medical devices costs. These costs were lower in older patients with SMA1, whereas they were stable across age groups in patients with SMA2+. End-of-life costs (excluding nusinersen) were high in both subgroups (€6,753 and €4,661 per month, respectively). This study highlights the high clinical and economic burden of SMA. The costs are higher in patients with Type 1 SMA (compared with patients with Types 2–4 SMA), especially in younger patients, and in the last months before death. Nusinersen injection represented the most expensive health expenditure, followed by hospitalization costs.

To estimate and compare costs associated with all-cause healthcare resource use (HCRU), stroke/systemic embolism (SE) and major bleedings (MB) between patients with non-valvular atrial fibrillation (NVAF) initiating apixaban and patients initiating other oral anticoagulants (OAC). An observational retrospective cohort generated from the French National Health System healthcare claims database (SNDS). Patients were included between 2014/01/01 and 2016/12/31 and followed until 2016/12/31. We used 4 sub-cohorts of AC-naive patients with NVAF, respectively initiating apixaban, dabigatran, rivaroxaban or VKAs. We matched patients initiating apixaban with patients initiating each of the other OACs using 1:n propensity score matching. We estimated all-cause HCRU costs and events-related costs from a medical care perspective by OAC treatment (euros) per patient per month (PPPM). We compared costs between matched patients initiating apixaban and those initiating each of the OAC using generalised linear models with gamma distribution and two-part models. There were 175,766 patients in the apixaban (n=68,208)-VKA (n=107,558) matched cohort, 42,490 in the apixaban (n=21,245)-dabigatran (n=21,245) matched cohort, and 181,809 in the apixaban (n=81,759)-rivaroxaban (n=100,050) matched cohort. Patients initiating apixaban had lower all-cause HCRU costs than patients initiating VKA (€1,105 vs. €1,578; p<0.0001), dabigatran (€993 vs. €1,140; p<0.0001) and rivaroxaban (€1,013 vs. €1,088; p<0.0001). Patients initiating apixaban also had lower costs related to stroke/SE and MB than patients initiating VKA (respectively €183 vs.€449; p<0.0001 and €147 vs.€413; p<0.0001), rivaroxaban (respectively €145 vs.€197; p<0.0001 and €129 vs.€193; p<0.0001), and lower costs related to stroke/SE than patients initiating dabigatran (€135 vs.€192; p<0.02). Costs related to MB were not significantly different in patients initiating apixaban versus patients initiating dabigatran (€119 vs.€149; p=0.07). All-cause HCRU and most events-related costs were lower in patients initiating apixaban compared to patients initiating other OAC. These findings suggest that apixaban may be cost-saving (all-cause HCRU costs) compared to all therapeutical alternatives.