{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T21:08:31Z","timestamp":1788383311192,"version":"build-2803163510"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Targeted therapies and immunotherapies prolong survival but are associated with high costs for patients with advanced non\u2013small cell lung cancer (aNSCLC). To date, little is known about survival and medication cost by biomarker status in the US.<\/jats:p><\/jats:sec>Objective<\/jats:title>To estimate survival and medication cost by aNSCLC biomarker status.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study using Flatiron Health data identified patients diagnosed with aNSCLC from January 1, 2016, through December 31, 2022. Each patient had received at least 1 biomarker test and 1 documented line of therapy; follow-up was through September 31, 2023. Patients were categorized based on the presence of driver alterations, including ALK<\/jats:italic> rearrangement, BRAF<\/jats:italic> variation, or EGFR<\/jats:italic> variation. Patients without driver alterations were divided into 3 groups based on their programmed cell death 1 ligand 1 (PD-L1) expression (&amp;lt;1%, 1%-49%, or \u226550%).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was medication costs, which were a function of survival probability and monthly medication costs. The secondary outcome was medication costs per survivor, defined as the mean aggregate medication costs within each patient cohort for each 1- or 2-year survivor.<\/jats:p><\/jats:sec>Results<\/jats:title>The study cohort consisted of 26\u202f635 patients with aNSCLC (mean [SD] age at diagnosis, 68.9 [10.0] years; 13\u202f750 [52%] male; 2610 [10%] African American, 687 [3%] Asian, 18 352 [69%] White, and 4986 [19%] other race, including any race other than African American, Asian, or White). The median overall survival was 39.9 (95% CI, 33.9-48.5) months for patients with ALK<\/jats:italic> rearrangement, 27.0 (95% CI, 24.8-28.8) months for EGFR<\/jats:italic> variation, 18.7 (95% CI, 16.0-20.6) months for BRAF<\/jats:italic> variation, 12.3 (95% CI, 12.0-12.7) months for PD-L1 less than 1%, 13.7 (95% CI, 13.1-14.3) months for PD-L1 of 1% to 49%, and 16.2 (95% CI, 15.3-17.0) months for PD-L1 of 50% or greater. The 1- and 2-year medication costs per patient for the overall cohort were $120\u202f420 (95% CI, $115\u202f540-$126\u202f470) and $182\u202f560 (95% CI, $172\u202f900-$196\u202f040), respectively. Patients with EGFR<\/jats:italic> variation or PD-L1\u2009of 50% or greater incurred relatively higher 1-year medication cost ($131\u202f700 [95% CI, $125\u202f340-$138\u202f280] and $123\u202f590 [95% CI, $115\u202f970-$130\u202f840], respectively) compared with patients with PD-L1 less than 1% ($110\u202f350 [95% CI, $101\u202f680-$120\u202f040]). Patients with ALK<\/jats:italic> rearrangement or EGFR<\/jats:italic> variation incurred the highest 2-year medication cost ($242\u202f130 [95% CI, $206\u202f220-$267\u202f330] and $241\u202f940 [95% CI, $230\u202f840-$254\u202f730], respectively), whereas patients with PD-L1\u2009less than 1% and PD-L1 of 1% to 49% had the lowest 2-year medication cost ($156\u202f340 [95% CI, $142\u202f450-$172\u202f800] and $163\u202f410 [95% CI, $152\u202f410-$174\u202f180], respectively). The medication costs per 1-year survivor were $152\u202f370 (95% CI, $133\u202f550-$178\u202f080) for patients with ALK<\/jats:italic> rearrangement, $175\u202f720 (95% CI, $167\u202f330-$185\u202f390) for EGFR<\/jats:italic> variation, $211\u202f100 (95% CI, $195\u202f030-$229\u202f400) for PD-L1\u2009less than 1%, $210\u202f260 (95% CI, $193\u202f190-$226\u202f580) for PD-L1 of 1% to 49%, and $211\u202f630 (95% CI, $198\u202f670-$224\u202f210) for PD-L1\u2009of 50% or greater, whereas the costs per 2-year survivor were $363\u202f480 (95% CI, $314\u202f710-$401\u202f320) for patients with ALK<\/jats:italic> rearrangement, $468\u202f400 (95% CI, $441\u202f340-$497\u202f860) for patients with PD-L1\u2009of 50% or greater, $460\u202f790 (95% CI, $427\u202f340-$494\u202f080) for patients with PD-L1 of 1% to 49%, and $500\u202f220 (95% CI, $456\u202f900-$556\u202f730) for patients with PD-L1\u2009less than 1%.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, patients with aNSCLC with driver alterations experienced better survival and incurred lower medication costs per survivor than those without driver variation, indicating the need to develop more affordable and effective medications for patients without driver alterations.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.14519","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T15:00:30Z","timestamp":1749567630000},"page":"e2514519","source":"Crossref","is-referenced-by-count":2,"title":["Biomarker-Specific Survival and Medication Cost for Patients With Non\u2013Small Cell Lung Cancer"],"prefix":"10.1001","volume":"8","author":[{"given":"Juanyi","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 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