Medical costs of lung cancer by stage, histology and first-line treatment modality in the Netherlands (2012–2021)

Introduction: 

Lung cancer is a leading cause of mortality worldwide, with lung cancer treatment presenting a significant financial burden. The treatment landscape has recently shifted, seeing an increase in targeted- and immunotherapies. Such treatments are expensive, but estimates of the medical costs of the lung cancer treatment pathway largely predate their introduction. 

Methods: 

We link medical expenditures of individuals resident in the Netherlands (n = 19.2 m) for 2013–2021 to tumour-level (n = 137,129, incident 2012–2021) Netherlands Cancer Registry data. We estimate lung cancer-attributable costs by phase of care (initial, continuing and terminal), stratified by cancer stage and histology, and observe trends in medical costs over time. 

Results: 

We estimate mean costs over the lung cancer treatment pathway to be €48,443 per patient. Total medical costs are highest in the initial phase, followed by the terminal and continuing phase. Monthly treatment for stage IV lung cancer is significantly more expensive than for early-stage disease (€8293 per month of initial care relative to €3228 for stage IA). Stage IV lung cancer has become significantly more expensive to treat 2018–2021 relative to 2013–2017, with monthly expenditures rising 55 % in initial care and 148 % in continuing care. Population-wide, we find €900.6 million spent on lung cancer care in 2021, €433 million more than in 2016, of which €307.3 million is attributed to per-patient expenditure trends. 

Conclusions: 

Treatment advances are quickly inflating medical costs for late-stage lung cancer. Policy makers should carefully evaluate the cost-effectiveness of novel treatments, and incorporate stage-specific treatment costs in evaluating interventions for early detection.