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

Author

Listed:
  • Lionel Perrier

    (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.)

  • 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)

  • Nathalie Havet

    (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)

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.

Suggested Citation

  • Lionel Perrier & Magali Morelle & Nathalie Havet & Anthony Montella & Bertrand Favier & David Perol & Frédéric Gomez & Marie-Odile Carrere & Paul Rebattu, 2009. "The effect of health care expenditures on survival in locally advanced and metastatic Non Small Cell Lung Cancer," Working Papers 0903, Groupe d'Analyse et de Théorie Economique Lyon St-Étienne (GATE Lyon St-Étienne), Université de Lyon.
    • Handle: RePEc:gat:wpaper:0903
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    References listed on IDEAS

    as
    1. Frank R. Lichtenberg, 2004. "The expanding pharmaceutical arsenal in the war on cancer," 2004 Meeting Papers 204, Society for Economic Dynamics.
    2. Martin, Stephen & Rice, Nigel & Smith, Peter C., 2008. "Does health care spending improve health outcomes? Evidence from English programme budgeting data," Journal of Health Economics, Elsevier, vol. 27(4), pages 826-842, July.
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    More about this item

    Keywords

    Cost; NSCLC; Oncology; Survival;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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