2.3 Cost
Because the study is about the treatment strategies in the initial
treatment phase, costs associated with the treatment of recurrence and
rehabilitation were assumed to be equivalent for NAC and AC. We also
assumed that the two treatment strategies have the same costs in
biochemical testing, imaging examination, pathological examination,
venipuncture related protocols and diagnosis. Cost calculation was only
done for medical related items that might make a big difference in NAC
and AC treatments.
Costs associated with (medical) caring for NSCLC patients included the
cost of surgery procedure, major late complications, chemotherapy
administration and chemotherapy adverse events (Table 3). The final cost
of the surgery was calculated as the sum of base surgical procedures
cost, additional surgical procedures cost and hospitalization costs
(including the cost of surgery complication). The surgery
(pneumonectomy, bi-lobectomy, lobectomy, or segmentectomy)
costs
were constructed from Medical programs fee schedule (MPFS) [29]. The
chemotherapy costs were measured the costs of main chemotherapy drugs
(paclitaxel and carboplatin). Based on recommendations in the current
guidelines, one cycle chemotherapy dosing was calculated as 200
mg/m2 for paclitaxel and an area under the curve of 6
for carboplatin, [2].
The major high-grade chemotherapy adverse events were neutropenia,
thrombocytopenia, anemia, nausea & vomiting, febrile neutropenia,
diarrhea, hyperglycemia, arthralgias, myalgias, fatigue, sensory
neuropathy, allergic reaction [3]. The definition of AE grade
followed that of the Common Terminology Criteria for Adverse Events
(CTCAE) Version 5.0 [27] and Guideline of Chinese Society Oncology
(CSCO) Primary Lung Cancer [28]. The costs of AE were estimated by
the core medical care components, empirical data, and expert opinion on
implementation strategies.
All cost estimates were calculated in 2020 RMB with the medical care
components of Consumer Price Index from the price dataset in Shanghai
Price Control Administration [29].