Cost Burden Associated with Advanced Non-Small Cell Lung Cancer (A-NSCLC): Impact of Disease Stage

To quantify the financial burden of A-NSCLC from a patient and caregiver perspective and to evaluate the impact of disease stage on costs. Financial data were collected between May 2015 and June 2016 as part of a multinational (France, Germany and Italy), cross-sectional study of adult patients with A-NSCLC (Stage IIIB/IV) and their informal caregivers. Data were obtained via medical chart reviews and patient and caregiver self-completion forms and included, but were not limited to: wage/productivity losses, formal/informal care requirements, government financial support and out-of-pocket expenses. Statistical significance was assessed using Mann–Whitney U tests. In total, 1030 patients and 427 accompanying informal caregivers were recruited. The majority of patients were receiving first-line therapy (70.5%); patients were largely receiving chemotherapy, regardless of line of therapy. Mean annual wage losses, productivity losses, unadjusted out-of-pocket costs and out-of-pocket costs adjusted for government financial support were €2076.86, €8743.73, €3774.33 and €822.66 (patients); and €436.47, €7041.79, €1755.59 and €1019.31 (caregivers). Mean annual societal costs for A-NSCLC were €12,588.64 (patients) and €7786.39 (caregivers). Mean annual wage losses, productivity losses, unadjusted out-of-pocket costs and out-of-pocket costs adjusted for government financial support were higher for Stage IV versus Stage IIIB disease for patients (€2281.84 vs €499.44, P=0.0135; €8791.00 vs €8438.62, P=NS; €4019.95 vs €1545.51, P=0.0306; €848.71 vs €583.73, P=NS) with a similar but non-significant trend for caregivers (€473.28 vs €0.00; €7180.15 vs €4482.07; €1893.61 vs €493.71; €1085.42 vs €414.40). Mean annual societal costs for A-NSCLC were higher for Stage IV disease for patients (€12,654.32 vs €11,918.75) and caregivers (€8015.91 vs €5261.57). A-NSCLC is associated with a substantial financial burden for patients, caregivers and society. In this analysis, mean annual societal costs for a patient with A-NSCLC and their accompanying caregiver support exceeded €20,000. Furthermore, the findings indicate that costs related to NSCLC increase as the disease progresses.