New insights into the cost-effectiveness of lung cancer treatment

Despite growing evidence that patients with advanced non-small-cell lung cancer have improved survival and better symptom control with modern systemic therapy, there is still resistance to the use of chemotherapy because of the perceived modest magnitude of benefit and concern about its cost. An analysis of the economic burden of care for non-small-cell lung cancer in Canada has revealed that the average cost to provide this care over 5 years is approximately $30,400 (1993 Canadian dollars). A large component of this cost, however, is related to initial diagnosis and in-hospital care, and to terminal care costs. Estimates of most of the commonly used chemotherapy regimens demonstrate that they are cost-effective and amount to less than the $20,000 per quality-adjusted life-year gained that is thought to be acceptable for the early adoption of a health-care intervention in Canada. Some chemotherapy regimens actually have the potential to decrease total health-care costs by reducing the use of acute care hospital beds for terminal care. Combined modality therapy for locally advanced non-small-cell lung cancer has also been shown to be cost-effective. The available evidence is that the cost of treating advanced non-small-cell lung cancer is not excessive, and estimates of cost-effectiveness are well within the commonly accepted range for the adoption of a new health-care technology.