Purpose: A systematic review of the literature was performed to understand the economic burden of managing advanced lung cancer.
Method: An electronic literature search of EMBASE, MEDLINE and HEALTHSTAR was performed (Jan 2000-August 1, 2010). The search terms “Lung Cancer” and “Costs and Cost Analysis” or “Economics” were used. Inclusion criteria: treatment costs for advanced (stage III-IV) non-small cell lung cancer (NSCLC). Exclusion criteria: mixed cancer or non-treatment costs, costs of early lung cancer, case reports, reviews, editorials, and conference reports. Two reviewers independently evaluated articles. Consensus agreement was reached for all included and excluded articles. Costs are reported in 2010 Canadian dollars.
Result: The literature search identified 3,654 abstracts: 44 articles were included. The articles spanned 17 countries. Cost identification (17) and cost-minimization (12) were the most common methodologies performed. Only 6 cost-utility analyses were completed. A perspective was reported in 30/44 studies and the most commonly chosen viewpoint for analysis was the healthcare system. The time horizon for collection of costs and health outcomes was missing in 8 studies and the time horizon used varied widely among studies. Sensitivity analyses were performed in 25/44 studies. Overall mean costs per patient for managing advanced NSCLC ranged from $25,439 to $96,958. The majority of articles reported mean costs per patient for chemotherapy and ranged from $1,121 (Vinorelbine) to $255,553 (Docetaxel). Mean costs of Gemicitabine + Cisplatin (8 studies) ranged from $4,243 to $69,970. Mean costs of Docetaxel (8 studies) ranged from $8,785 to $255,553.
Conclusion: Lung cancer is the leading cause of cancer-related mortality worldwide. The majority of patients are ineligible for curative surgical treatment. The cost of caring for advanced lung cancer is extremely high. The literature includes few cost-utility studies which should be of greater priority in a non-curative population. This systematic review will help to inform future economic evaluations in the area of advanced NSCLC. Population-based phase IV trials evaluating the costs and effects of advanced NSCLC treatment are lacking and are necessary to further the work completed alongside randomized controlled trials.
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