Real-World Costs and Healthcare Resource Utilization for Patients With Metastatic Non-Small Cell Lung Cancer and PD-L1 TPS ≥50% in the United States

Objectives
Despite treatment advances, few real-world studies have characterized US economic outcomes in metastatic non‒small cell lung cancer (mNSCLC) with programmed cell death-ligand 1 (PD-L1) tumor proportion score (TPS) ≥50% and no actionable genomic aberrations. This study evaluated all-cause and NSCLC-specific costs and healthcare resource utilization (HCRU) in this population.

Methods
This retrospective, observational study used de-identified data from a multimodal database (Tempus AI, Inc.). Index date was the date of metastatic treatment initiation; follow-up was ≥3 months from index date until death, loss to follow-up, or study end. Eligible patients were 18−89 years old diagnosed with mNSCLC between January 1, 2016−September 15, 2025; had initiated systemic therapy for metastatic disease; and had PD-L1 TPS ≥50% with confirmed absence of EGFR, ALK, and ROS-1 aberrations. Costs and HCRU were examined during the post-index period and categorized by care setting. Visit costs (inpatient, outpatient, office) and HCRU were reported as mean (SD) per patient per month (PPPM).

Results
Overall, 174 patients were included in this study (mean age, 68.9 years; male, 53.4%; White, 70.7%; Medicare, 66.7%; stage IV at diagnosis, 70.7%). Total all-cause costs were $13,810.75 (13,321.32) PPPM, with total NSCLC-specific costs of $9454.88 (11,775.37). The majority of total all-cause costs stemmed from outpatient visits ($3785.51 [$6944.91]) and office visits ($6985.88 [$10,235.20]), with corresponding NSCLC-specific costs of $1352.49 ($4200.70) and $6308.84 ($10,088.13). All-cause mean hospitalizations totaled 0.5 (2.35) PPPM and NSCLC-specific hospitalizations totaled 0.17 (0.87) PPPM, with length of stay of 2.20 (3.73) and 2.46 (4.02) days, respectively. There were 1.64 (1.81) and 1.93 (2.07) PPPM all-cause outpatient and office visits, respectively, and 0.61 (0.94) and 1.26 (1.70) PPPM NSCLC-specific visits, respectively.

Conclusions
All-cause and NSCLC-specific costs and HCRU, driven primarily by outpatient and office visits, demonstrate a considerable economic burden in the first-line setting for patients with PD-L1 TPS ≥50% without actionable genomic aberrations.