Factors Associated With Use of High-Cost Agents for the Treatment of Metastatic Non-Small Cell Lung Cancer

J Natl Cancer Inst. 2020 Aug 1;112(8):802-809. doi: 10.1093/jnci/djz223.


Background: Antineoplastic agents approved in recent decades are a marked advancement in cancer treatment, but they 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 use of high-cost antineoplastic agents for the treatment of metastatic non-small cell lung cancer.

Methods: We conducted a retrospective observational study using 2007-2015 Surveillance, Epidemiology, and End-Results-Medicare data supplemented with the Area Health Resource File. Patients were aged 66 years and older, were enrolled in fee-for-service Medicare Part D, were diagnosed with a first primary diagnosis of metastatic non-small cell lung cancer, and had 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 (eg, National Cancer Institute designation).

Results: Patients who lived in areas of high poverty were 4 percentage points less likely to receive high-cost agents (two-sided P < .001). Patients who were not treated at a National Cancer Institute-designated center were 10 percentage points less likely to receive these agents (two-sided P < .001). A 27 percentage-point increase in the likelihood of receiving a high-cost agent was observed in 2015, as compared to 2007, highlighting the rapid change in practice patterns (two-sided P < .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 the treatment of metastatic non-small cell lung cancer alone.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / economics*
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / economics
  • Carcinoma, Non-Small-Cell Lung / epidemiology
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Drug Costs* / statistics & numerical data
  • Female
  • Health Care Costs
  • Humans
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / economics
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / pathology
  • Male
  • Medicare / economics
  • Neoplasm Metastasis
  • Retrospective Studies
  • Risk Factors
  • SEER Program
  • United States / epidemiology


  • Antineoplastic Agents