The effect of health care expenditures on survival in locally advanced and metastatic Non Small Cell Lung Cancer

Lionel Perrier, Magali Morelle (), Nathalie Havet (), Anthony Montella, Bertrand Favier, David Pérol (), Frédéric Gomez, Marie-Odile Carrère and Paul Rebattu
Additional contact information
Magali Morelle: GATE - Groupe d'analyse et de théorie économique - UL2 - Université Lumière - Lyon 2 - ENS LSH - Ecole Normale Supérieure Lettres et Sciences Humaines - CNRS - Centre National de la Recherche Scientifique
Anthony Montella: Centre Léon Bérard [Lyon]
Bertrand Favier: Centre Léon Bérard [Lyon]
David Pérol: Centre Léon Bérard [Lyon]
Frédéric Gomez: Centre Léon Bérard [Lyon]
Marie-Odile Carrère: GATE - Groupe d'analyse et de théorie économique - UL2 - Université Lumière - Lyon 2 - ENS LSH - Ecole Normale Supérieure Lettres et Sciences Humaines - CNRS - Centre National de la Recherche Scientifique
Paul Rebattu: Centre Léon Bérard [Lyon]

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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 Léon Bérard Regional Cancer Center (Lyon, France). Survival data were modelled 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. 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 (search for similar items in EconPapers)
Date: 2009
Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-00371825v1
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Published in 2009

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Working Paper: The effect of health care expenditures on survival in locally advanced and metastatic Non Small Cell Lung Cancer (2009)
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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:halshs-00371825

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