2.1 Model Structure
We created a decision tree model using the software package Tree-Age pro 2011 to compare the health and economic impact of NAC and AC for cT2-4N0-1 NSCLC patients from the payer’s perspective. Costs were measured using a China Medicare care perspective, and outcome of patients include OS, quality-adjusted life-years (QALYs), health utilities value and treatment time. The utility of disease was calculated according to published utilities. The event outcome was informed by the study of Brandt et al.
In the model, patients received either surgery followed by four rounds of adjuvant chemotherapy, or 2 rounds of neoadjuvant chemotherapy followed by lung surgery and an additional 2 rounds of adjuvant chemotherapy. We assumed that the chemotherapy regimen was intravenous paclitaxel/carboplatin, for the previous study had showed there was no significant association of chemotherapy regimens for NAC and AC and there was no significant difference in the survival for different chemotherapy regimens [10]. For every set of chemotherapy cycles, patients could experience grade 3 or 4 chemotherapy-related adverse events (AE). Meanwhile, during the surgery (both NAC and AC), the patient also could experience surgery complications. If patients experienced adverse event (AE) or complications from chemotherapy or surgery respectively, they could either recover or die from the event (Fig.1). The goals of our study were to compare the cost-effectiveness in the initial stage and the treatment stage. Cost and prognosis for patients treated with NAC and AC during the progressive stage were not included in the model.