2.3 Cost
Because the study is about the treatment strategies in the initial treatment phase, costs associated with the treatment of recurrence and rehabilitation were assumed to be equivalent for NAC and AC. We also assumed that the two treatment strategies have the same costs in biochemical testing, imaging examination, pathological examination, venipuncture related protocols and diagnosis. Cost calculation was only done for medical related items that might make a big difference in NAC and AC treatments.
Costs associated with (medical) caring for NSCLC patients included the cost of surgery procedure, major late complications, chemotherapy administration and chemotherapy adverse events (Table 3). The final cost of the surgery was calculated as the sum of base surgical procedures cost, additional surgical procedures cost and hospitalization costs (including the cost of surgery complication). The surgery (pneumonectomy, bi-lobectomy, lobectomy, or segmentectomy) costs were constructed from Medical programs fee schedule (MPFS) [29]. The chemotherapy costs were measured the costs of main chemotherapy drugs (paclitaxel and carboplatin). Based on recommendations in the current guidelines, one cycle chemotherapy dosing was calculated as 200 mg/m2 for paclitaxel and an area under the curve of 6 for carboplatin, [2].
The major high-grade chemotherapy adverse events were neutropenia, thrombocytopenia, anemia, nausea & vomiting, febrile neutropenia, diarrhea, hyperglycemia, arthralgias, myalgias, fatigue, sensory neuropathy, allergic reaction [3]. The definition of AE grade followed that of the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 [27] and Guideline of Chinese Society Oncology (CSCO) Primary Lung Cancer [28]. The costs of AE were estimated by the core medical care components, empirical data, and expert opinion on implementation strategies.
All cost estimates were calculated in 2020 RMB with the medical care components of Consumer Price Index from the price dataset in Shanghai Price Control Administration [29].