Factors Associated with Utilization of High Cost Agents for the Treatment of Metastatic Non-small Cell Lung Cancer


Antineoplastic agents approved in recent decades are a marked advancement in cancer treatment but come at considerable cost. These drugs may widen survival disparities between patients who receive these agents and those who do not. We examine factors associated with the utilization of high cost antineoplastic agents for the treatment of metastatic non-small cell lung cancer (mNSCLC).


We conducted a retrospective observational study using 2007-2015 SEER-Medicare data supplemented with the Area Health Resource File. Patients were aged 66 years or older enrolled in fee-for-service Medicare Part D, were diagnosed with a first primary diagnosis of mNSCLC, and received an antineoplastic agent. High cost agents were defined as agents costing $5000 or more per month. Independent variables include race/ethnicity, urban or rural residency, census tract poverty, and treatment facility type (e.g., National Cancer Institute (NCI) designation).


Patients who lived in areas of high poverty were 4 percentage points less likely to receive high cost agents (two-sided p < 0.001). Patients who were not treated at a NCI designated center were 10 percentage points less likely to receive these agents (two-sided p < 0.001). A 27 percentage point increase in the likelihood of receiving a high cost agent was observed in 2015 compared to 2007, highlighting the rapid change in practice patterns (two-sided p < 0.001).


Potential policy and care delivery solutions involve outreach and support to community physicians who treat patients in remote areas. We estimate that widespread use of these agents conservatively cost approximately $3 billion per year for metastatic non-small cell lung cancer alone.

 2019 Nov 9. pii: djz223. doi: 10.1093/jnci/djz223. [Epub ahead of print]