Journal of Clinical Oncology, Vol 15, 3038-3048, Copyright © 1997 by American Society of Clinical Oncology
Cost of combined modality interventions for stage III non-small-cell lung cancer
WK Evans, BP Will, JM Berthelot and CC Earle
University of Ottawa, Ontario, Canada. bevans@octrf.on.ca
PURPOSE: To evaluate the cost-effectiveness (CE) of new combined modality
strategies in patients with stage III non-small-cell lung cancer (NSCLC).
METHODS: Recent studies suggest that combined modality therapy confers a
survival advantage for patients with stage III NSCLC. Using the Statistics
Canada (Ottawa, Canada) lung cancer costing model, we have evaluated the CE
of these interventions using 1993 Canadian health care costs and the
perspective of the government as payer in a universal health care system.
RESULTS: We estimate that the cost to treat a stage IIIa NSCLC patient with
preoperative and postoperative chemotherapy would increase by $15,886, and
a similar combined modality approach with the addition of postoperative
radiotherapy would increase the cost by $22,963. Chemoradiotherapy for
stage IIIb NSCLC would produce a smaller incremental cost of approximately
$8,912 per case. However, these approaches are remarkably cost-effective,
with cost per life-year gained (LYG) ranging from $3,348 to $14,958.
Administering all chemotherapy in the outpatient department would improve
CE. For sensitivity analysis, we reduced the survival gain that resulted
from the three interventions by 25% and 50%, and increased the hospital per
diem rates by 10%, 20%, and 30%. CONCLUSION: Even with the most adverse
assumptions, the CE estimates were all considered acceptable for new health
care technologies in Canada. Overall, it appears that neoadjuvant therapy
for stage IIIa NSCLC and combined modality therapy for stage IIIb NSCLC are
cost-effective. Economic considerations should not be a barrier to their
adoption.
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