Healthcare resource utilization and costs of US patients with small cell lung cancer treated with second-line therapies: a retrospective real-world database study

Aims To examine all-cause and myelosuppressive event (MYSPE)-related healthcare resource utilization and costs among patients with small cell lung cancer (SCLC) in the United States treated with second-line therapies.Materials and Methods This retrospective cohort study of the Optum Market Clarity database included adult patients with SCLC who completed platinum-based first-line induction therapy and initiated second-line treatment (1 January 2020 to 31 May 2023); second-line treatment initiation was the index date. Patients were continuously enrolled for at least 1 month after the index date. Total standardized all-cause and MYSPE-related costs were calculated. Adjusted 12‑month costs were estimated using Lin’s weighted regression.Results The final analysis included 1,063 patients across 5 treatment cohorts: lurbinectedin monotherapy (N = 350), platinum-based chemotherapy (with any agent except lurbinectedin) (N = 249), immuno-oncology therapy (without lurbinectedin, topotecan, or platinum) (N = 154), topotecan-based therapy (without lurbinectedin or platinum) (N = 138), and other combinations (N = 172). Lurbinectedin monotherapy was associated with fewer MYSPEs than chemotherapies; mean MYSPE-related per-patient per-month costs were $1,407 with lurbinectedin monotherapy compared to $1,791 with platinum-based therapy and $2,314 with topotecan-based therapy. Mean unadjusted all-cause per-patient per-month costs were $24,274 in the lurbinectedin monotherapy cohort, $24,069 in the immuno-oncology therapy cohort, and $25,074 in the platinum-based therapy cohort. Mean adjusted 12-month all-cause costs of lurbinectedin monotherapy ($168,975) were lower than the costs for platinum-based ($249,914; p < 0.001) or immuno-oncology ($220,258; p = 0.004) therapies and higher than the costs for topotecan-based therapy ($121,865; p < 0.001).Limitations There may be misclassification or under-identification of SCLC cases due to the absence of specific SCLC diagnosis codes and potential underreporting of MYSPEs.Conclusions Lurbinectedin monotherapy was associated with decreased all-cause healthcare costs compared to platinum-based and immuno-oncology therapies, but not topotecan-based therapy, and decreased MYSPEs and MYSPE-related costs compared with chemotherapies.