Impact of immunotherapy on overall survival and healthcare costs in advanced/metastatic lung cancer: A real-world study in France.

INTRODUCTION

While immunotherapies have shown a substantial overall survival (OS) benefit in clinical trials, their effectiveness and costs should be assessed in real-world setting. This study aims to assess OS and healthcare costs in advanced/metastatic lung cancer patients treated or not with immunotherapy in real-world setting.

METHODS

We performed a retrospective analysis using the French Health Data System from 2010 to 2020. Patients treated with immunotherapy for advanced/metastatic lung cancer between 2017 and 2020 were included in the IMMUNO cohort. We used two control cohorts (ADVANCED and METASTATIC) of similar patients receiving a first systemic treatment between 2012 and 2016 (before immunotherapy reimbursement in France). Propensity scores were used to match IMMUNO patients and control patients according to immunotherapy line (IMMUNO-L1, IMMUNO-L2). Healthcare costs were estimated from the French national health insurance perspective for first-line cohorts, starting from the first systemic treatment.

RESULTS

The IMMUNO-L1 cohort comprised 15,118 patients, the IMMUNO-L2 cohort 15,935 patients, the ADVANCED cohort 47,762 patients and the METASTATIC cohort 40,137 patients. After matching, median OS was 14.9 months (interquartile range (IQR): 4.5-43.9) in IMMUNO-L1 vs 7.5 months (IQR: 3.3-15.9) and 7.4 months (3.4-14.5) in IMMUNO-L1 and METASTATIC-L1 respectively. The average monthly cost was €8,801 [95 %CI: 8,684-8,917] in IMMUNO-L1, €4,205 [4,137-4,273] in ADVANCED-L1 and €4,314 [4,250-4,378] in METASTATIC-L1. The mean cumulated healthcare cost per patient was €57,561 [95 %CI: 56,707-58,414] in IMMUNO-L1, €14,399 [14,182-14,617] in ADVANCED-L1 and €15,121 [14,904-15,338] in METASTATIC-L1.

CONCLUSION

Lung cancer patients treated with immunotherapy show better real-world survival outcomes at a higher cost than standard historical chemotherapy regimens. However, the survival benefit of immunotherapy appears lower in routine practice than in clinical trials.