Cost‐effectiveness of chemotherapy combined with thoracic radiotherapy versus chemotherapy alone for limited stage small cell lung cancer: A population‐based propensity‐score matched analysis

Abstract

Background: The addition of thoracic radiotherapy improves the outcome of limited stage small cell lung cancer (LS-SCLC), however, the cost-effectiveness of this process has never been reported. We aimed to estimate the short-term costeffectiveness of chemotherapy combined with thoracic radiotherapy (C-TRT) versus chemotherapy alone (C/T) for LS-SCLC patients from the payer's perspective (Taiwan National Health Insurance). Methods: We identified LS-SCLC patients diagnosed within 2007-2009 through a comprehensive population-based database containing cancer and death registries, and reimbursement data. The duration of interest was one year within diagnosis. We included potential confounding covariables through literature searching and our own experience, and used a propensity score to construct a 1:1 population for adjustment. We used a net benefit (NB) approach to evaluate the cost-effectiveness at various willingness-to-pay (WTP) levels. Sensitivity analysis regarding potential unmeasured confounder(s) was performed. Results: Our study population constituted 74 patients. The mean cost (2013 USD) and survival (year) was higher for C-TRT (42 439 vs. 28 357; 0.94 vs. 0.88). At the common WTP level (50 000 USD/life-year), C-TRT was not cost effective (incremental NB − 11 082) and the probability for C-TRT to be cost effective (i.e. positive net benefit) was 0.005. The result was moderately sensitive to potential unmeasured confounder(s) in sensitivity analysis. Conclusions: We provide evidence that when compared to C/T, C-TRT is effective in improving survival, but is not cost-effective in the short-term at a common WTP level from a payer's perspective. This information should be considered by clinicians when discussing thoracic radiotherapy with their LS-SCLC patients.

Comparative effectiveness of concurrent chemoradiotherapy versus EGFR‐tyrosine kinase inhibitors for the treatment of clinical stage IIIb lung adenocarcinoma patients with mutant EGFR

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Comparison of intensity-modulated radiotherapy vs 3-dimensional conformal radiotherapy for patients with non-metastatic esophageal squamous cell carcinoma receiving definitive concurrent chemoradiotherapy

“…The selection and definition (including grouping of quantitative variables) of these factors were based on our experiences in clinical care and modified from our prior TCR-related studies. [15–20] The tumor/node/metastasis classification was based on 6th edition (2008–2009 cases) or 7th edition (2010–2015 cases). The definitions of our covariables were as follows.…”

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

“…Secondly, we collected additional factors that might affect both the use and cost of NCCRT for locally advanced esophageal cancer patients based on our clinical and research experiences. In this regard, we also included patient demographic factors (age, gender, and residency), patient characteristics (comorbidity, SES), disease (stage), and health service provider characteristics (treating hospital level and surgeon's experience) based on our clinical experiences and prior NHI Research Database (NHIRD) and HWDC related studies . Patient residency was classified as northern Taiwan or non‐north; hospital was classified as medical centers or regional hospitals.…”