Cost-effectiveness
of neoadjuvant versus
adjuvant
chemotherapy for cT2-4N0-1
non-small
cell lung cancer patients during initial treatment phase
Abstract
Objective:The 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.
Method: A decision tree model was designed from a payer
perspective to compare NAC and AC treatments for NSCLC. Parameters
included overall survival (OS), surgical complications, chemotherapy
adverse event (AE), 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.
Result: With the same
overall survival, AC treatment strategy produces
a
cost saving of ¥618.90 and an incremental quality-adjusted life-years
(QALY) of 0.10 years per patient. If median OS of NAC is 1.4 months more
than AC, NAC would be cost effective (CE) at a ¥35446/QALY threshold.
The model was robust enough to handle variations to all input parameters
except the overall survival. In the probability sensitivity analysis, AC
remained dominant in 54.6% of simulations.
Conclusion: The modeled cost effectiveness analysis indicates
that with operable NSCLC, AC treatment is more cost effective compared
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 analysis.
Key words: cost-effectiveness, neoadjuvant chemotherapy,
adjuvant chemotherapy,
non-small
cell lung cancer