Evans W K, Will B P, Berthelot J M, Earle C C
University of Ottawa, Ontario, Canada.
J Clin Oncol. 1997 Sep;15(9):3038-48. doi: 10.1200/JCO.1997.15.9.3038.
To evaluate the cost-effectiveness (CE) of new combined modality strategies in patients with stage III non-small-cell lung cancer (NSCLC).
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.
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%.
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.
评估新的联合治疗策略对Ⅲ期非小细胞肺癌（NSCLC）患者的成本效益（CE）。
近期研究表明，联合治疗可使Ⅲ期NSCLC患者获得生存优势。利用加拿大统计局（加拿大渥太华）的肺癌成本模型，我们采用1993年加拿大医疗保健成本，并从全民医疗保健系统中作为支付方的政府角度，评估了这些干预措施的成本效益。
我们估计，对Ⅲa期NSCLC患者进行术前和术后化疗的治疗成本将增加15,886美元，采用类似的联合治疗方法并增加术后放疗，成本将增加22,963美元。Ⅲb期NSCLC的放化疗每例产生的增量成本较小，约为8,912美元。然而，这些方法具有显著的成本效益，每获得一个生命年（LYG）的成本在3,348美元至14,958美元之间。在门诊进行所有化疗将提高成本效益。对于敏感性分析，我们将三种干预措施带来的生存获益降低了25%和50%，并将每日住院费用提高了10%、20%和30%。
即使在最不利的假设下，加拿大新医疗技术的成本效益估计值仍被认为是可接受的。总体而言，Ⅲa期NSCLC的新辅助治疗和Ⅲb期NSCLC的联合治疗似乎具有成本效益。经济因素不应成为采用这些治疗方法的障碍。
