US Patients With NSCLC Demonstrate Higher Rates of Health Care Utilization and Costs

Key Takeaways:

• In an international systematic literature analysis, researchers found that US patients with advanced non-small cell lung cancer (NSCLC) had higher rates of health care resource utilization (HCRU) than those in other countries, including hospitalizations, emergency department (ED) visits, and outpatient visits.
• In the US, average total care costs for NSCLC ranged from $57 730 to $159 908, which may be attributed to the increased use of immune checkpoint inhibitors (ICIs) after 2015.
• Innovative strategies such as low-dose computed tomography (LDCT) screening and enhanced biomarker testing could help relieve the substantial economic burden of NSCLC on patients and health systems.

Researchers conducted a global, systematic literature review of the economic burden of advanced NSCLC. The study assessed HCRU and medical costs across countries in North and South America, Europe, and Asia.

The quality analysis included 50 articles, representing 43 unique studies, from Excerpta Medica Database (Embase) and Medical Literature Analysis and Retrieval System Online (MEDLINE) that were published between 2011 and January 2025. These publications explored the economic burden of locally advanced (stage IIIB/C) and metastatic (stage IV) NSCLC.

Health Care Utilization

The US had higher rates of hospitalization over 11 to 24 months. The mean number of all-cause hospitalizations ranged from 1.2 to 2.8, with an average length of stay of 2.1 to 16.4 days. The most common reasons for hospitalizations included adverse events (AEs), treatment administration, surgical interventions, and complications.

During first- and second-line treatment, patients receiving immunotherapy had lower rates of hospitalization than patients receiving chemotherapy. Hospitalization rates were higher among patients with central nervous system (CNS) metastases than patients without CNS metastases, 67.1% vs 57.1%, respectively. US patients with exon20i EGFR mutations had more hospitalizations than patients with other types of EGFR mutations.

The US had 12.6% of patients with ED visits, which was the second-highest percentage among the various countries. Rates of ED visits were similar across different first-line treatments.

The US also had higher rates of all-cause outpatient visits, averaging from 34.4 to 48 visits over 12 months. Just as with hospitalizations, rates of outpatient visits were higher among patients with CNS metastases than those without. For most countries included in the study, the percentage of outpatient visits during first- and second-line treatment was 86%.

The most common diagnostic tests include imaging, biopsy, and laboratory tests. Diagnostic testing was used by 27% of patients in the US. Between 2010 and 2018, the average number of laboratory tests increased from 2.7 to 3.8 per patient per year (PPPY). The use of diagnostic testing was higher among patients with CNS metastases and EGFR mutations.

Care Costs

Average total costs for advanced NSCLC ranged from $57 730 to $159 908 in the US over an 11- to 24-month period. This substantial spending is likely due to the increased use of ICIs after 2015. The main drivers of spending also included hospitalization costs, outpatient costs, and chemotherapy costs.

Combined immunotherapy and chemotherapy had the highest per patient per month (PPPM) costs in the US compared to chemotherapy and immunotherapy alone, $32 436 vs $19 000 vs $17 763, respectively.

Total care costs decreased with subsequent lines of treatment. First-line therapy costs averaged $80 206, second-line had an average of $61 662, and third-line had a mean cost of $54 997.

Similar to rates of HCRU, patients with CNS metastases accumulated higher total care costs than those without.

Other factors associated with higher care costs include disease progression, comorbidities, higher educational status, private insurance, and higher use of health care utilization and treatment.

Reducing Economic Burden for Advanced NSCLC

The researchers identified multiple strategies that may lower the economic burden associated with NSCLC treatment. Expanding risk-targeted LDCT screening can lead to earlier diagnosis, reducing long-term HCRU and costs. Advances in biomarker testing could help optimize first-line treatment and lower overall health care utilization.

The authors said, “Together, these findings highlight the scale and drivers of economic burden in advanced NSCLC and underscore the importance of strategies aimed at earlier detection, optimized treatment selection, and more efficient care delivery.”

Reference

Jovanoski N, Kaur G, Shukla H, Chana N, Kharawala S. Economic burden of advanced non-small cell lung cancer (NSCLC): a systematic literature review. J Med Econ. 2026;29(1):433-454. doi:10.1080/13696998.2026.2623789