Treatment patterns and healthcare resource utilization and payments in patients with lung cancer in the Texas Medicaid program

The economic burden associated with the treatment of lung cancer is substantial. With the introduction of targeted therapy and immunotherapy, treatment options for lung cancer management have expanded in recent years. However, little is known about treatment patterns and healthcare utilization and payments for lung cancer patients enrolled in the Texas Medicaid program. The objective of this study was to evaluate treatment patterns and healthcare resource utilization and payments for lung cancer patients enrolled in Texas Medicaid. A total of 453 newly diagnosed lung cancer patients were identified between 2004 and 2021. There were significant differences in proportions of patients receiving chemotherapy, targeted therapy, and immunotherapy by treatment line (p<0.0001). Chemotherapy was the most frequently prescribed first-line treatment for enrollees with lung cancer (363, 80.1%). Immunotherapy (53, 11.7%), the second most used first-line treatment, exceeded targeted therapy (37, 8.2%). Only one-third (146) of patients received subsequent-line treatment, in which immunotherapy increased greatly. Platinum-based doublets were the main first-line treatment while single-agent chemotherapy dominated in subsequent line. Office visits (mean=19.5) and outpatient visits (mean=13.6) accounted for the majority of healthcare resource utilization during the 1-year follow-up period. Compared to the chemotherapy group, immunotherapy had a significantly higher number of office visits while targeted therapy had a significantly lower number of office visits. Targeted therapy also had a significantly lower number of ED visits. Consistent with healthcare resources utilization, payments associated with office visits and outpatient visits were primary drivers of payments. Compared to the chemotherapy group, the immunotherapy group had 160.93% higher total payments (p<0.0001), while the targeted therapy group had 29.99% lower total payments (p=0.1818). Findings from our study showed that although chemotherapy was still the mainstream treatment for lung cancer, the treatment landscape has shifted to immunotherapy. This could be attributed to a decreased utilization of chemotherapy and increased utilization of immunotherapy in subsequent-line treatment. Meanwhile, the greater use of immunotherapy might be a driving factor for more outpatient visits and office visits associated with higher payments. Future studies of real-world use of immunotherapy are needed to better understand the economic burden.