For patients with advanced EGFR- and ALK-positive non-small cell lung cancer (NSCLC), higher out-of-pocket costs for tyrosine kinase inhibitors (TKIs) was linked to worse overall survival (OS), reported a retrospective cohort study in JCO Oncology Practice.

Using the Hutchinson Institute for Cancer Outcomes Research registry claims database, study authors identified patients who were diagnosed with stage IV EGFR- and ALK-positive NSCLC between January 1, 2010, and December 31, 2015. All patients included in the analysis had health insurance and at least 1 pharmacy claim for an EGFR or ALK TKI.

Patients were grouped into quartiles based on their average monthly OOP costs for TKIs. Patients in the highest quartile had a median monthly TKI OOP cost of $2888, while patients in the lower quartiles had a cost of $1431.

Continue Reading

A total of 27 patients were in the highest quartile and were considered “exposed” to high OOP costs, while the remaining 78 patients in the lower quartiles were not exposed and served as controls.

Multivariate analysis revealed that patients exposed to high OOP costs for TKIs had a higher likelihood of death compared with patients who were not exposed (hazard ratio [HR], 1.85; 95% CI, 1.11-3.10; P =.019).

Exposed patients were also less inclined to adhere to TKI treatment (odds ratio [OR], 0.28; 95% CI, 0.10-0.76) and more inclined to stop treatment (OR, 8.75; 95% CI, 2.59-29.52), according to multivariate analysis.

“Our results suggest that patients incurring very high TKI OOP costs possibly are at higher risk of death,” the study authors wrote. “Lower TKI adherence and early TKI discontinuation at least in part mediate the associations of higher TKI OOP costs with inferior survival.”

The study authors reasoned that patients with Medicare drove these observations because overall survival, TKI adherence, and TKI discontinuation differed significantly among Medicare patients, but not those with commercial insurance.

“Compared with Medicare, commercially insured patients incurred lower TKI OOP costs and probably had access to financial assistance programs from drug manufacturers, whereas federal legislation prohibits Medicare beneficiaries from applying for such assistance,” the study authors speculated.


Goulart BHL, Unger JM, Chennupati S, Fedorenko CR, Ramsey SD. Out-of-pocket costs for tyrosine kinase inhibitors and patient outcomes in EGFR- and ALK-positive advanced non-small-cell lung cancer. JCO Oncol Pract. Published online December 7, 2020. doi:10.1200/OP.20.00692