2.2 Effectiveness and quality of life
Based on the study by Brandt et al. there was no significant difference
in median OS between NAC and AC. So, we assumed that the OS (9.1 years)
and quality of life (QOL) during the progression-free survival stage
were equal. The parameters like probabilities of AE and complications,
are also based on the published results in this study, which are listed
in Table 1. As data for postoperative death couldn’t be sourced, 30-day
mortality and 90-day mortality information was integrated into
postoperative complication mortality. Based on this study, the patients
treated with neoadjuvant chemotherapy all received the lung cancer
surgery, and the patients treated with surgery as the initial therapy,
all received the adjuvant chemotherapy. In considering chemotherapy
tolerance, we take the proportion of grade 3 and 4 AE as the input
parameter. There were no deaths for chemotherapy and AE.
Quality of life was estimated using standard health utility weights. The
utility weights of stable disease and progressive-free disease were
calculated according to published study[22][24]. As there is a
shortage of quality of life studies in the case of lung cancer surgery
complications, we use the utility value of pneumothorax in the study of
Handorf et al [24] as the 3 and 4 grade complication utility
weights. The average utility weight of every treatment procedure was
shown in 2, and the time frames of each treatment are based on the study
of Dendulur et al [21] and Lugg et al [25]. In the model, the
treatment of patients with 3 or 4 grade AE will add 0.73 months to basic
time of surgery and chemotherapy, while treatment of those with 3 or 4
grade complication will add 0.5 months. The utility weight of patients
with 3 or 4 grade AE and complication were 0.45. The utility weight
during the time 6 months after initial treatment remained unchanged.