Impact of immunotherapy on overall survival and healthcare costs in advanced/metastatic lung cancer: A real-world study in France
Menée en France à partir de données de vie réelle 2010-2020 portant sur des patients atteints d'un cancer du poumon de stade avancé ou métastatique, cette étude rétrospective évalue l'effet des immunothérapies sur la survie globale et les coûts de santé
Introduction: While immunotherapies have shown a substantial overall survival (OS) benefit in clinical trials, their effectiveness and costs should be assessed in real-world setting. This study aims to assess OS and healthcare costs in advanced/metastatic lung cancer patients treated or not with immunotherapy in real-world setting.
Methods: We performed a retrospective analysis using the French Health Data System from 2010 to 2020. Patients treated with immunotherapy for advanced/metastatic lung cancer between 2017 and 2020 were included in the IMMUNO cohort. We used two control cohorts (ADVANCED and METASTATIC) of similar patients receiving a first systemic treatment between 2012 and 2016 (before immunotherapy reimbursement in France). Propensity scores were used to match IMMUNO patients and control patients according to immunotherapy line (IMMUNO-L1, IMMUNO-L2). Healthcare costs were estimated from the French national health insurance perspective for first-line cohorts, starting from the first systemic treatment.
Results: The IMMUNO-L1 cohort comprised 15,118 patients, the IMMUNO-L2 cohort 15,935 patients, the ADVANCED cohort 47,762 patients and the METASTATIC cohort 40,137 patients. After matching, median OS was 14.9 months (interquartile range (IQR): 4.5–43.9) in IMMUNO-L1 vs 7.5 months (IQR: 3.3–15.9) and 7.4 months (3.4–14.5) in IMMUNO-L1 and METASTATIC-L1 respectively. The average monthly cost was €8,801 [95 %CI: 8,684–8,917] in IMMUNO-L1, €4,205 [4,137–4,273] in ADVANCED-L1 and €4,314 [4,250–4,378] in METASTATIC-L1. The mean cumulated healthcare cost per patient was €57,561 [95 %CI: 56,707–58,414] in IMMUNO-L1, €14,399 [14,182–14,617] in ADVANCED-L1 and €15,121 [14,904–15,338] in METASTATIC-L1.
Conclusion: Lung cancer patients treated with immunotherapy show better real-world survival outcomes at a higher cost than standard historical chemotherapy regimens. However, the survival benefit of immunotherapy appears lower in routine practice than in clinical trials.
Lung Cancer , résumé, 2026