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 Perol (), Frédéric Gomez (), Marie-Odile Carrere () and Paul Rebattu ()
Additional contact information
Magali Morelle: University of Lyon, Lyon, F-69003, France; CNRS, UMR 5824, GATE, Ecully, F-69130, France; ENS LSH, Lyon, F-69007, France ; Centre Leon Berard, Lyon, F-69003, France
Anthony Montella: University of Lyon, Lyon, F-69003, France; Centre Leon Berard, Lyon, F-69003, France.
Bertrand Favier: University of Lyon, Lyon, F-69003, France; Centre Leon Berard, Lyon, F-69003, France
David Perol: University of Lyon, Lyon, F-69003, France; Centre Leon Berard, Lyon, F-69003, France
Frédéric Gomez: University of Lyon, Lyon, F-69003, France; Centre Leon Berard, Lyon, F-69003, France.
Marie-Odile Carrere: University of Lyon, Lyon, F-69003, France; CNRS, UMR 5824, GATE, Ecully, F-69130, France; ENS LSH, Lyon, F-69007, France ; Centre Leon Berard, Lyon, F-69003, France
Paul Rebattu: University of Lyon, Lyon, F-69003, France; Centre Leon Berard, Lyon, F-69003, France

No 903, Working Papers from Groupe d'Analyse et de Théorie Economique Lyon St-Étienne (GATE Lyon St-Étienne), Université de Lyon

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 Ä35,160. 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)
JEL-codes: I12 I18 (search for similar items in EconPapers)
Pages: 33 pages
Date: 2009
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ftp://ftp.gate.cnrs.fr/RePEc/2009/0903.pdf (application/pdf)

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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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