# Cost Disparities with Age in the Treatment of Advanced Non-Small-Cell Lung Cancer (NSCLC) in Ontario, Canada

## TL;DR

Older patients with advanced lung cancer in Ontario had higher initial healthcare costs but lower cancer-related costs after diagnosis compared to younger patients.

## Contribution

This study identifies age-related cost disparities and treatment phase-specific cost drivers in advanced NSCLC care.

## Key findings

- CACs decreased with age across all phases of care after cancer diagnosis.
- Chemotherapy increased costs in early phases but reduced end-of-life costs.
- Baseline healthcare costs were higher for older patients.

## Abstract

Previous studies have noted associations between age and healthcare costs in non-small-cell lung cancer (NSCLC). However, the drivers of cost disparities have not yet been fully examined. This retrospective cohort study included deceased patients diagnosed with stage IV NSCLC in Ontario from 1 April 2008 to 30 March 2014. Variables of interest were extracted from the Institute for Clinical Evaluative Sciences. Average monthly cancer-attributable costs (CACs), defined as the net additional costs due to cancer, determined by subtracting pre-diagnosis costs from post-diagnosis costs, were calculated by phases of care (staging, initial, continuing, and end-of-life). Regression analyses assessed predictors of cost variability. The median age of the 14,655 patients was 65 to 69 years; 54% were male and 29% had received chemotherapy. On both univariate and multivariate analysis, CACs decreased with age after cancer diagnosis across all phases of care (p < 0.001). Receiving chemotherapy contributed to higher costs in staging, initial, and continuing phases (OR 2.11, 95% C.I. 1.90–2.33, p < 0.01), and lower costs in the end-of-life phase (OR 0.77, 95% C.I. 0.72–0.81, p < 0.01). Our study showed that older patients had higher baseline healthcare costs and lower cancer-attributable costs following diagnosis of advanced NSCLC. Cost drivers, including treatment and gender, varied by phase of care.