Cost-effectiveness analysis of neoadjuvant versus adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer patients during initial treatment phase

Cost Effectiveness and Resource Allocation

Chunji Huang¹  Hao Huang²  Dongdong Wu²  Juan Li³  Yubo Wang⁴ 

[1] Army Medical University, Gaotan Rock, Shapingba District, 400038, Chongqing, China;Department of Information, Daping Hospital, Army Medical University, Chongqing, China;Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China;Respiratory Department, Daping Hospital, Army Medical University, Chongqing, China;

关键词: Cost-effectiveness;    Neoadjuvant chemotherapy;    Adjuvant chemotherapy;    Non-small cell lung cancer;   

DOI  :  10.1186/s12962-021-00280-w

来源: Springer

【 摘 要 】

ObjectiveThe choice between neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) remains controversial in the treatment of non-small cell lung cancer (NSCLC). There is no significant difference in NAC and AC’s effectiveness. We investigate the cost-effectiveness of NAC versus AC for NSCLC.MethodA decision tree model was designed from a payer perspective to compare NAC and AC treatments for NSCLC patients. Parameters included overall survival (OS), surgical complications, chemotherapy adverse events (AEs), treatment initiation probability, treatment time frame, treatment cost, and quality of life (QOL). Sensitivity analyses were performed to characterize model uncertainty in the base cases.ResultAC treatment strategy produced a cost saving of ¥3064.90 and incremental quality-adjusted life-years (QALY) of 0.10 years per patient with the same OS. NAC would be cost-effective at a ¥35,446/QALY threshold if the median OS of NAC were 2.3 months more than AC. The model was robust enough to handle variations to all input parameters except OS. In the probability sensitivity analysis, AC remained dominant in 54.4% of simulations.ConclusionThe model cost-effectiveness analysis indicates that with operable NSCLC, AC treatment is more cost-effective to NAC. If NAC provides a longer survival advantage, this treatment strategy may be cost-effective. The OS is the main factor that influences cost-effectiveness and should be considered in therapeutic regimes.

【 授权许可】

CC BY