The Effect of Health Care Expenditures on Survival in Locally Advanced and Metastatic Non Small Cell Lung Cancer

33 Pages Posted: 17 May 2009 Last revised: 24 May 2010

See all articles by Lionel Perrier

Lionel Perrier

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE)

Magali Morelle

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE)

Nathalie Havet

University of Lyon II - Groupe dAnalyse et de Théorie Economique (GATE)

Anthony Montella

affiliation not provided to SSRN

Bertrand Favier

affiliation not provided to SSRN

David Perol

affiliation not provided to SSRN

Frederic Gomez

affiliation not provided to SSRN

Marie Odile Carrere

affiliation not provided to SSRN

Paul Rebattu

affiliation not provided to SSRN

Date Written: February 1, 2009

Abstract

Context: The significant survival benefit of chemotherapy over best supportive care for locally advanced and metastatic NSCLC has been amply demonstrated in the literature. However, there is no clear evidence of the impact of the type of chemotherapy or of a superiority of combination chemotherapy over single-agent chemotherapy.

Objective: The present study empirically examines, in real-life practise and using multiple proxies, the impact of health care expenditures on overall survival in locally advanced and metastatic NSCLC in order to guide medical decision-making.

Methods: Disease characteristics, the resources used, the costs of treatment and survival data were retrospectively collected from the records of 175 patients treated between 2000 and 2004 at Leon Berard Regional Cancer Center (Lyon, France). Survival data were modeled using multivariate Cox models and controlled for endogeneity with the instrumental variable method.

Results: The median survival for the whole cohort was 289 days. The average total cost of treatment reached 35,160 Euros. Survival was significantly shorter for patients with stage IV disease, poor performance status, and past or concomitant cardiovascular disease and/or diabetes, for current smokers, and for patients with adenocarcinoma compared to large cell carcinoma. Survival duration was not significantly associated with the total cost of treatment per day of hospitalisation, the number of chemotherapy drugs administered, nor inpatient length of stay.

Conclusion: Higher care expenditures do not appear to improve survival for patients with locally advanced or metastatic NSCLC. Hence, maintaining patient quality of life and tailoring therapy to stage, histology and comorbidities appears to be the less bad choice.

Keywords: Cost, NSCLC, Oncology, Survival

JEL Classification: I12, I18

Suggested Citation

Perrier, Lionel and Morelle, Magali and Havet, Nathalie and Montella, Anthony and Favier, Bertrand and Perol, David and Gomez, Frederic and Carrere, Marie Odile and Rebattu, Paul, The Effect of Health Care Expenditures on Survival in Locally Advanced and Metastatic Non Small Cell Lung Cancer (February 1, 2009). Available at SSRN: https://ssrn.com/abstract=1405290 or http://dx.doi.org/10.2139/ssrn.1405290

Lionel Perrier (Contact Author)

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE) ( email )

93, chemin des Mouilles
Ecully, 69130
France

Magali Morelle

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE) ( email )

93, chemin des Mouilles
Ecully, 69130
France

Nathalie Havet

University of Lyon II - Groupe dAnalyse et de Théorie Economique (GATE) ( email )

93, chemin des Mouilles
Ecully, 69130
France

Anthony Montella

affiliation not provided to SSRN

Bertrand Favier

affiliation not provided to SSRN

David Perol

affiliation not provided to SSRN

Frederic Gomez

affiliation not provided to SSRN

Marie Odile Carrere

affiliation not provided to SSRN ( email )

Paul Rebattu

affiliation not provided to SSRN

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