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

Dongdong Wu,Chunji Huang,Juan Li,Yubo Wang,Hao Huang

doi:10.1186/s12962-021-00280-w

Dongdong Wu, Chunji Huang + Show 3 more

Open Access

https://doi.org/10.1186/s12962-021-00280-w

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Abstract

ObjectiveThe 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.MethodA decision tree model was designed from a payer perspective to compare NAC and AC treatments for NSCLC patients. Parameters included overall survival (OS), surgical complications, chemotherapy adverse events (AEs), 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.ResultAC treatment strategy produced a cost saving of ¥3064.90 and incremental quality-adjusted life-years (QALY) of 0.10 years per patient with the same OS. NAC would be cost-effective at a ¥35,446/QALY threshold if the median OS of NAC were 2.3 months more than AC. The model was robust enough to handle variations to all input parameters except OS. In the probability sensitivity analysis, AC remained dominant in 54.4% of simulations.ConclusionThe model cost-effectiveness analysis indicates that with operable NSCLC, AC treatment is more cost-effective 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 and should be considered in therapeutic regimes.

Highlights

Non-small cell lung cancer (NSCLC) is a frequent malignancy and the most common cause of cancer-related deaths among males and females globally, resulting in a large social and economic burden [1]
The model cost-effectiveness analysis indicates that with operable NSCLC, adjuvant chemotherapy (AC) treatment is more costeffective to neoadjuvant chemotherapy (NAC)
A study by Brandt et al evaluated whether the treatment strategy of NAC or AC was better for cT2-4N0-1 NSCLC patients through a propensity score match analysis [10]

Summary

Introduction

Non-small cell lung cancer (NSCLC) is a frequent malignancy and the most common cause of cancer-related deaths among males and females globally, resulting in a large social and economic burden [1]. The original purpose of administering chemotherapy before surgery included: improving operability by reducing tumor tissue size, increasing the likelihood of administering the maximum planned dose. A study by Brandt et al evaluated whether the treatment strategy of NAC or AC was better for cT2-4N0-1 NSCLC patients through a propensity score match analysis [10]. They analyzed 92 matched-pair patients and demonstrated that there was no significant difference in DFS and OS between treatment cohorts. The NATCH trial recruited 624 patients with stage I–IIIA, N0–N1 NSCLC to compare the effect of three therapeutic strategies (NAC, AC, and surgery alone) [3]. The meta-analysis of trials did not demonstrate differences in OS and DFS between NAC and AC [12, 13]

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