Lung cancer drugs do not increase life expectancy in elderly

A US-based study has found that survival for elderly patients with lung cancer has changed little despite big healthcare spending increases on new drugs.

The study by Harvard University's National Cancer Institute and the National Bureau of Economic Research, which was published in the 1 December 2007 issue of 'Cancer', the journal of the American Cancer Society, showed that average life-expectancy rose by less than one month between 1983 and 1997, while costs increased by over USD 20,000 per patient.

The US spends more than USD 5bn a year on lung cancer detection, determining the disease severity and drug treatment. The spend level is a significant increase over the last few decades and mirrors similar increases in general healthcare spending over the same period.

The one-year survival rate for lung cancer has increased slightly, from 37 per cent in 1975 to 1979 to 42 per cent in 2002, thanks to improvements in surgical techniques and combined therapies. However the five-year survival rate for all stages of lung cancer combined has remained static and is currently only about 16 per cent.

Dr Rebecca Woodward and colleagues linked and analysed non-small cell lung cancer (NSCLC) survival data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database and Medicare Parts A and B reimbursement data from the Continuous Medicare History Sample File (CMHSF) database. The study objective was to examine changes in treatment costs and outcomes for localised, regional and metastatic lung cancer from the early 1980s to the mid-1990s.

Cost-effectiveness, as measured by the cost of an additional year of life gained, was rated as 'poor', with a high average cost of USD 403,142. While early stage cancer treatment was more cost-effective by conventional standards than treatments for advanced disease, the gains still were limited.

When analysed by disease severity, the cost per additional year gained for local and regional disease was USD 143,614 and USD 145,861, respectively. For metastatic cancer, the cost per additional year gained was USD 1.2m.

Woodward concluded: "The additional money spent on lung cancer treatment in the mid-1990s, compared with in the early 1980s did not result in a favourable economic rate of return by conventional benchmarks."