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Economic Burden of Recurrence in Completely Resected Stage IB-IIIA Non-Small Cell Lung Cancer: A Retrospective Study Using Nationwide Claims Data of South Korea

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Abstract

Introduction

Although many patients with early stage non-small cell lung cancer (NSCLC) experience recurrence despite complete resection, few studies have reported on the corresponding economic burden. This study aimed to understand the economic impact of recurrence by measuring healthcare costs and resource utilization in patients with recurrent stage IB-IIIA NSCLC.

Methods

Using Health Insurance Review and Assessment claims data from South Korea, we included patients who underwent complete resection for stage IB-IIIA NSCLC during the index period (January 1, 2012, to October 31, 2018). Patients who experienced recurrence were matched with those who did not using 1:1 propensity score (PS) matching. The mean healthcare costs and resource utilization were analyzed from the date of complete resection to the last claims for cancer treatment. A generalized linear model (GLM) was used to estimate the impact of covariates on healthcare costs. A difference-in-difference (DID) analysis was conducted to analyze the healthcare costs between the two groups before and after recurrence.

Results

Patients with recurrence incurred higher healthcare costs, particularly in outpatient settings. The cost of targeted therapy and immune checkpoint inhibitors primarily contributed to cost differences, and medication costs increased over time after complete resection. Patients with recurrence were also hospitalized more frequently (9.3 vs. 5.0, p < 0.0001) for a longer period (74 days vs. 42 days, p < 0.0001) than those without recurrence. GLM analysis showed that the total cost was 2.31-fold higher in patients with recurrence (95% confidence interval: 2.19–2.44). The DID analysis showed significantly increased total costs in patients with recurrence (β = 26,269, p < 0.0001), which was mostly attributed to medication costs (β = 17,951, p < 0.0001).

Conclusion

Recurrence of completely resected NSCLC leads to a substantial increase in healthcare costs and resource utilization. The results of this study show the economic burden of recurrence, which may help future economic analyses and resource allocation.

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Acknowledgements

Funding

In this study, the journal’s Rapid Service Fees was supported by AstraZeneca, Korea.

Medical Writing, Editorial, and Other Assistance

We would like to thank Editage (http://www.editage.co.kr) for English language editing.

Authorship

All authors meet the International Committee of Medical Journal Editors’ criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

Conceptualization: Joo-Young Byun, Ju-Eun Lee, Yoon-Bo Shim, Mi-Hai Park, and Eui-Kyung Lee. Methodology: Joo-Young Byun, Ju-Eun Lee, Yoon-Bo Shim, Mi-Hai Park, and Eui-Kyung Lee. Formal analysis and Investigation: Joo-Young Byun, Ju-Eun Lee; Writing—original draft preparation: Joo-Young Byun and Ju-Eun Lee. Writing—review and editing: Joo-Young Byun, Ju-Eun Lee, Jihyun Kim, Sun Young Lee, Bo Ra Shin, Na Ri Yoon, Mi-Hai Park, and Eui-Kyung Lee. Funding acquisition: Eui-Kyung Lee; Resources: Mi-Hai Park, Eui-Kyung Lee; Supervision: Mi-Hai Park, Eui-Kyung Lee. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this article and have approved this version for publication.

Disclosures

Joo-Young Byun, Ju-Eun Lee, and Yoon-Bo Shim have nothing to disclose. Mi-Hai Park and Eui-Kyung Lee have received research grants from AstraZeneca. Jihyun Kim, Sun Young Lee, Bo Ra Shin, and Na Ri Yoon are the employees of AstraZeneca.

Compliance with Ethics Guidelines

This study was approved by the institutional review board of Sungkyunkwan University (IRB no. SKKU202101026). This study was a retrospective cohort analysis using healthcare claims data from the Health Insurance Review & Assessment (HIRA) of South Korea; therefore, the requirement for informed consent was waived. The HIRA data used in this study were anonymously recorded.

Data Availability

The datasets generated in this study are potentially identifiable from the corresponding author on reasonable request but are not publicly available owing to ethical restrictions by the HIRA.

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Author notes

  1. Joo-Young Byun and Ju-Eun Lee contributed equally to this work and share the first authorship.

Authors and Affiliations

  1. School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea

    Joo-Young Byun, Ju-Eun Lee, Yoon-Bo Shim, Na Ri Yoon, Mi-Hai Park & Eui-Kyung Lee

  2. AstraZeneca Korea, Seoul, Republic of Korea

    Jihyun Kim, Sun Young Lee, Bo Ra Shin & Na Ri Yoon

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Byun, JY., Lee, JE., Shim, YB. et al. Economic Burden of Recurrence in Completely Resected Stage IB-IIIA Non-Small Cell Lung Cancer: A Retrospective Study Using Nationwide Claims Data of South Korea. Adv Ther 40, 550–567 (2023). https://doi.org/10.1007/s12325-022-02358-0

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