Cost of treatment of metastatic non-small lung cancer in Sweden, 2011-2023.

BACKGROUND AND PURPOSE: Metastatic non-small cell lung cancer (mNSCLC) contributes to the economic burden. Over the past decade, treatment has evolved with the introduction of epidermal growth factor receptor (EGFR) anaplastic lymphoma kinase (ALK)-targeted, and immune-oncology (IO) drugs. However, limited evidence exists on the long-term costs of mNSCLC treatments in Sweden. Patient/material and methods: This population-based retrospective study used data from the National Board of Health and Welfare, identifying patients initially diagnosed with stage IV NSCLC between 2011 and 2020. Healthcare costs, including inpatient care, outpatient care, and drug expenses, were assessed using Diagnosis-Related Group (DRG) tariffs and prescription data. Drug expenses exceeding DRG tariff limits, such as IO drugs, were calculated separately based on retail list prices. Costs were analyzed over 5 years post-diagnosis and adjusted to 2023 values.

RESULTS

A total of 17,107 patients were included. IO drug use increased sharply after 2016, becoming the predominant therapy. EGFR- and ALK-targeted drug use steadily increased. Overall costs rose over time, especially in the first year after diagnosis. The first-year mean cost was highest among patients receiving IO drugs (€105,286), primarily due to drug acquisition, but declined in subsequent years. ALK- and EGFR-targeted therapies also had high initial costs but remained stable thereafter.

INTERPRETATION: This study highlights the increasing economic burden of mNSCLC treatment in Sweden, driven by the targeted and IO drugs. While ALK-, EGFR-targeted, and IO drugs contribute to high first-year mean costs, IO drug costs decline significantly in subsequent years after diagnosis.