The economic burden of brain metastasis among lung cancer patients in the United States

Objective:Brain metastases among lung cancer patients can impair cognitive and functional ability, complicate care, and reduce survival. This study focuses on the economic burden of brain metastasis in lung cancerdirect healthcare costs to payers and indirect costs to patients, payers, and employersin the US.Methods:Retrospective study using claims data from over 60 self-insured Fortune 500 companies across all US census regions (January 1999-March 2013). Adult, non-elderly lung cancer patients with brain metastasis were evaluated over two study periods: (1) pre-diagnosis (30 days prior to first observed lung cancer diagnosis to 30 days prior to first-observed brain metastasis diagnosis) and (2) post-diagnosis (30 days prior to first observed brain metastasis diagnosis to end of continuous eligibility or observation).Outcome measures:Healthcare costs to payers and resource utilization, salary loss to patients, disability payouts for payers, and productivity loss to employers.Results:A total of 132 patients were followed for a median of 8.4 and 6.6 months in the pre- and post-diagnosis periods, respectively. At diagnosis of brain metastasis, 21.2% of patients were on leave of absence and 6.1% on long-term disability leave. Substantial differences were observed in the pre- vs post-diagnosis periods. Specifically, patients incurred much greater healthcare utilization in the post-diagnosis period, resulting in $25,579 higher medical costs per-patient-per-6-months (PPP6M). During this period, patients missed significantly more work days, generating an incremental burden of $2853 PPP6M in salary loss for patients, $2557 PPP6M in disability payments for payers, and $4570 PPP6M in productivity loss for employers.Limitations:Type of primary lung cancer and extent of brain metastasis could not be assessed in the data. The analysis was also limited to patients with comprehensive disability coverage.Conclusions:Development of brain metastasis among lung cancer patients is associated with a substantial economic burden to payers, patients, and employers.