||5R01CA072663-03 Interpret this number
||Dana-Farber Cancer Institute
||Cost Effectiveness of Lung Cancer Chemotherapy
Lung cancer is the leading cause of cancer death in the US.
Metastatic non-small cell lung cancer (NSCLC), an incurable
disease, accounts for the vast majority of these deaths.
Chemotherapy may prolong life by a matter months and may
relieve symptoms in some, but is toxic and expensive. Therefore,
best supportive care (BSC) that does not involve cytotoxic
chemotherapy is considered a reasonable alternative. Preferences
regarding tradeoffs between the potential benefits of chemotherapy
for NSCLC and its toxicity are not well understood. Furthermore,
it is unclear whether these benefits are sufficient to justify the
economic costs to society. We propose to address these questions
by performing a state-of-the-art cost-effectiveness analysis (CEA)
comparing chemotherapy with BSC as the initial treatment strategy
for NSCLS. Development and evaluation of innovative yet user-
friendly methods to estimate each of the components of the cost-
effectiveness ratio will be stressed. The proposed study will
proceed in four steps. First, we will estimate the incremental
survival benefit associated with chemotherapy using the results of a
meta-analysis of randomized controlled trials and population-based
tumor registry data. Second, we will collect primary utility and
health-related quality of life (HRQL) data from patients and
calculate the incremental quality-adjusted life years resulting from
chemotherapy. Third, we will combine data from three sources -
hospital cost data on a cohort of patients treated at the Dana-Farber
Cancer Institute and Brigham and women~s Hospital, surveys on
time and out-of-pocket costs among those same patients, and
National Health Care Finance Administration claims data linked
with SEER clinical data -- to estimate the incremental cost of
chemotherapy. Finally, we will combine these data to perform a
CEA of chemotherapy versus BSC in NSCLC, with particular
attention to how the cost-effectiveness results vary with different
perspectives on costs and preferences for health outcomes. This
study would represent the first comprehensive attempt to calculate
the cost-effectiveness of chemotherapy versus BSC for NSCLC
patients. The research will help identify the most effective
treatment strategies, taking into account not just survival, but also
HRQL. The findings will guide policy makers and payers in
making clinical and resource allocation decisions. And by
developing new methodologic techniques, the research will lead to
more efficient and valid CEAs of a wide array of Medical
Impact of referral patterns on the use of chemotherapy for lung cancer.
, Neumann P.J.
, Gelber R.D.
, Weinstein M.C.
, Weeks J.C.
Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2002-04-01 00:00:00.0; 20(7), p. 1786-92.