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