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Katharina Verleger, 1 John R Penrod, 2 Melinda Manley Daumont, 3 Caitlyn Solem, 4 Linlin Luo, 4 Cynthia Macahilig, 5 Nadine Hertel 6 1Pharmerit International, Berlin, Germany; 2Bristol-Myers Squibb, Princeton, NJ, USA; 3Bristol-Myers Squibb, Braine-L’alleud, Belgium; 4Pharmerit International, Bethesda, MD, USA; 5Medical Data Analytics, Parsippany, NJ, USA; 6Bristol-Myers Squibb, Uxbridge, UKCorrespondence: Katharina VerlegerPharmerit International, Krausenstr 8, Berlin 10117, GermanyTel +49 30 3080 7024Email kverleger@pharmerit.comPurpose: Advanced non-small-cell lung cancer (aNSCLC; stage IIIB/IV) presents a substantial clinical burden to society; reliable estimates of its economic burden are lacking. Therefore, this study aimed to quantify real-world health care resource utilization (HCRU) and costs of patients with squamous (SQ) and non-SQ (NSQ) aNSCLC who received two or more lines of treatment (2L+) in Europe, and to describe cost-predictors.Methods: The LENS (Leading the Evaluation of Non-squamous and Squamous NSCLC) retrospective chart review study collected data from 2L+ patients with aNSCLC diagnosed between 07/2009 and 08/2011 (wave 1) or 07/2010 and 09/2012 (wave 2) in France, Germany, Italy, Spain, England, the Netherlands, and Sweden. Patients were followed from diagnosis through most recent visit/death. A weighted average of country-specific unit costs (2018 Euro) was applied to systemic anti-cancer therapy usage and HCRU (hospital/emergency department visit, surgery, radiotherapy, ancillary care, biomarker testing) to determine the total cost from aNSCLC diagnosis to death. Generalized linear models (gamma distribution, log link) were used to assess clinical and demographic predictors.Results: Of 973 2L+ aNSCLC patients, median overall survival (OS) was 1.5 years from advanced diagnosis (range: 0.2– 5.3; median OS: 1.4 [SQ], 1.6 [NSQ]), 79.0% died during follow-up. Weighted mean total per-patient costs were € 21,273, ranging from € 17,761 (England) to € 30,854 (Sweden), and € 15,446 (SQ) to € 26,477 (NSQ). Systemic drug costs comprised 77.4% of total costs. Insurance status, presence of epidermal growth factor receptor (EGFR) mutation, SQ histology, age, alcohol abuse, and year of diagnosis were significant predictors for lower total costs per patient-month, Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 1 and country for higher costs.Conclusion: In the era pre-immunotherapy, HCRU and costs were substantial in aNSCLC 2L+ patients, with most of the costs accrued prior to start of 2L. NSQ patients incurred significantly higher total costs than SQ patients in all participating countries.Keywords: carcinoma, non-small-cell lung, observational study, cost of illness, health care costs