Real-world hospital costs for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer in Chinese patients: a retrospective cohort study

Jianhua Chen,¹ Shengqi Wu,² Chenping Hu,³ Yicheng Yang,⁴ Narayan Rajan,⁵ Yun Chen,⁴ Canjuan Yang,⁶ Jianfeng Li,⁶ Wendong Chen<sup>7

1</sup>Department of Medical Oncology, ²Department of Research and Education, Hunan Province Tumor Hospital, ³Department of Respiratory, Xiangya Hospital, Central South University, Changsha, Hunan, ⁴Lilly Suzhou Pharmaceutical Co., Ltd. Shanghai Branch, Shanghai, People's Republic of China; ⁵Global Health Outcomes Research, Eli Lilly and Co, Indianapolis, IN, USA; ⁶Division of Health Outcome Research, Normin Health Changsha Representative Office, Changsha, Hunan, People's Republic of China; ⁷Normin Health, Toronto, ON, Canada

Objective: The objective of this study was to compare hospital costs per treatment cycle (HCTC) for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer (AdvNS-NSCLC) in Chinese patients.
Methods: Patients receiving platinum-based doublets in the first-line setting for AdvNS-NSCLC from 2010 to 2012 in two Chinese tertiary hospitals were identified to create the retrospective study cohort. Propensity score methods were used to create matched treatment groups for head-to-head comparisons on HCTC between pemetrexed–platinum and other platinum-based doublets. Multiple linear regression analyses were performed to rank studied platinum-based doublets for their associations with the log₁₀ scale of HCTC for nonchemotherapy drugs and nondrug care.
Results: Propensity score methods created matched treatment groups for pemetrexed–platinum versus docetaxel–platinum (61 pairs), paclitaxel–platinum (39 pairs), gemcitabine–platinum (93 pairs), and vinorelbine–platinum (73 pairs), respectively. Even though the log₁₀ scale of HCTC for nonchemotherapy drugs and nondrug care associated with pemetrexed–platinum was ranked lowest in all patients (coefficient –0.174, P=0.015), which included patients experiencing any hematological adverse events (coefficient –0.199, P=0.013), neutropenia (coefficient –0.426, P=0.021), or leukopenia (coefficient –0.406, P=0.001), pemetrexed–platinum had the highest total HCTC (median difference from RMB 1,692 to RMB 7,400, P<0.001) among platinum-based doublets because of its higher drug acquisition costs (median difference from RMB 4,636 to RMB 7,332, P<0.001).
Conclusion: Among Chinese patients receiving platinum-based doublets in the first-line setting for AdvNS-NSCLC, the higher acquisition costs for nonplatinum cytotoxic drugs associated with pemetrexed–platinum could be partially offset by its significantly lower hospital costs for nonchemotherapy drugs and nondrug care.

Keywords: nonsquamous non-small-cell lung cancer, hospital costs, platinum-based doublet, first line, Chinese