Second-Line Trial Participation in Metastatic NSCLC Associated With Notable Cost Savings for Health Care Payers

Patients with metastatic non–small cell lung cancer who participated in a second-line clinical trial appeared to have an association with a notable monthly cost saving for health care payers over the course of their participation, according to the results of a study published in the Journal of Clinical Oncology.

Clinical trial participation for this patient population was associated with a $6663 mean cost savings per patient per month and a mean saving of $45,308 per patient over the course the study for health care payers. Findings from the secondary analysis that was conducted by the primary insurance payer indicated that the difference-in-difference for patients with commercial insurance was -$5526 (P =.26) compared with -$7432 (P = .01) for patients with Medicare.

“Although this is a retrospective single- institution study, these data provide an updated analysis of the costs of trial participation in an evolving oncology treatment landscape. If our results hold in larger confirmatory studies, health care payers should have a financial incentive to improve clinical trial access and enrollment,” the investigators wrote.

Of 70 eligible patients, 22 were enrolled into a second-line clinical trial. Patients tended to be younger, with a mean age of 64, and were more likely to be female (73%). Additionally, 36% of patients were never smokers and the population was less likely to have brain metastases (14%).

A total of 86% (n = 19) of patients died compared with 96% (n = 46) in nonparticipants. The median overall survival was 1.7 years (95% CI, 0.6-2.4) for trial participants, and 1.0 years (95% CI, 0.8-1.4 years) for nonparticipants.

During first-line therapy, the median time from metastatic disease to diagnosis for trial participants was 14 days compared with 18 days for nonparticipants. The median time from metastatic diagnosis to the end of second line therapy was 13.1 months for trial participants and 13.8 months for nonparticipants. Patients who enrolled on the trial were 50% more likely to receive a PD-L1 inhibitor or 45% more likely to receive another targeted therapy at any time during treatment. Of the 22 patients, 27% (n = 6) were enrolled in at least 1 other trial beyond the second-line therapy study.

In terms of first-line therapy, the mean per patient per month total directed medical costs to health care payers demonstrated similarities between patients in a second-line trial and nonparticipants (Standard deviation [SD], $10,393 ± $6250 vs SD, $11,473 ± $10,858). In terms of second-line therapy, the mean per patient per month total directed medical costs differed significantly by $4808 (SD) ± $3370 for patients in a second-line trial compared with $12,551 (SD) ± $13,598 for nonparticipants. The differences between second-line therapy and first-line therapy per patient per month total direct medical costs decreased in patients who participated in a second-line trial (Difftrial SD, -$5585 ± $6541; P<.001), although, it increased for nonparticipants (Diffnontrial SD, $1078 ± $14,765; P =.62).

The per patient per month total directed medical costs in the secondary analysis for patients with commercial insurance was lower for 8 patients in a second-line trial compared with 18 nonparticipants in the first-line therapy (SD, $15,100 ± $6764 vs SD, $19,173 ± $13,479), as well as patients during the second-line therapy (SD, $6464 ± $2983 vs SD, $16,063 ± $11,245). In terms of differences between second-line and first-line trials, investigators also reported a decrease in total direct medical costs per patient per month among those in a the second-line trial (Difftrial SD, -$8635, SD ± $8485; P = .02) and nonparticipants (Diffnontrial SD, -$3110 ± $15,814; P =.42).

Over a mean duration 8.9 months for patients on a second-line clinical trial, a savings of $49,181 per year per patient was observed for commercial insurance payers.

Among patients with Medicare, the mean total direct medical costs per patient per month for 14 patients enrolled on a second-line trial and 30 nonparticipants were similar throughout first-line therapy (SD, $7703 ± $4128 vs SD, $6854, SD ± $5069). For patients in second-line therapy, the mean per patient per month costs was lower for trial participants (SD, $3861, SD ± $3302) than nonparticipants (SD, $10,444 ± $14,605). 

Patients with Medicare had a mean duration of second-line therapy of 5.6 months, which translated to a savings of $41,619 per patients on trial for health care payers.

Reference

Merkhofer C, Chennupati S, Sun Q, et al. Effect of clinical trial participation on costs to payers in metastatic non-small-cell lung cancer. JCO Oncol Pract. 2021;17(8):e1225-e1234. doi:10.1200/OP.20.01092