BACKGROUND 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). METHODS 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). RESULTS 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). CONCLUSION 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.

中文翻译：

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与使用高成本药物治疗转移性非小细胞肺癌相关的因素。


背景技术近几十年来批准的抗肿瘤剂是癌症治疗的显着进步，但成本相当高。这些药物可能会扩大接受这些药物的患者与未接受这些药物的患者之间的生存差异。我们研究了与使用高成本抗肿瘤药物治疗转移性非小细胞肺癌（mNSCLC）相关的因素。方法 我们使用 2007-2015 年 SEER-Medicare 数据并辅以区域卫生资源文件进行了一项回顾性观察研究。患者年龄为 66 岁或以上，参加了按服务付费医疗保险 D 部分，首次被诊断为 mNSCLC，并接受了抗肿瘤药物治疗。高成本代理被定义为每月花费 5000 美元或以上的代理。自变量包括种族/族裔、城市或农村居住地、人口普查区贫困和治疗设施类型（例如国家癌症研究所 (NCI) 名称）。结果 生活在高度贫困地区的患者接受高成本药物的可能性降低了 4 个百分点（双侧 p < 0.001）。未在 NCI 指定中心接受治疗的患者接受这些药物的可能性降低 10 个百分点（双侧 p < 0.001）。与 2007 年相比，2015 年接受高成本代理的可能性增加了 27 个百分点，凸显了实践模式的快速变化（双边 p < 0.001）。结论 潜在的政策和护理提供解决方案涉及对偏远地区治疗患者的社区医生的外展和支持。我们保守估计，仅用于转移性非小细胞肺癌，广泛使用这些药物每年就花费约 30 亿美元。