Economics of the clinical management of lung cancer in France: an analysis using a Markov model.
To evaluate, according to the histologic type and initial stage, the mean cost (MC) of managing patients with lung cancer and the costs of the different management phases. A Markov approach was used to model these costs, based on the management of a representative nation-wide sample of 428 patients with newly diagnosed lung cancer. The 18-month MC ranged from US$ 20 691 (95% CI: 5777-50 380 for diffuse non-small-cell lung cancer (NSCLC) to US$ 31 833 (95% CI: 15 866-64 455) for localised small-cell lung cancer (SCLC); first-line treatment costs ranged from 33.8% of MC for medically inoperable localised NSCLC to 74.6% for diffuse SCLC; second- or third-line treatment costs ranged from 7.8% of MC for surgically treated localised NSCLC to 32% for locally advanced NSCLC; and the cost of palliative care ranged from 9.1% of MC for locally advanced NSCLC to 39.9% for medically inoperable localised NSCLC. The cost of first-line chemotherapy and the percentage of actively treated patients impacted more on MC than did the cost of second- or third-line chemotherapy regimens or the cost of palliative care. In conclusion, this model provides a robust economic analysis of the cost of lung cancer management, and will be useful for assessing the economic consequences of future changes in patient management.
Chouaïd
C
C
Service de Pneumologie, Hôpital St Antoine, 184 rue du Fbg St Antoine, Paris Cedex 12 75571, France. christos.chouaid@sat.ap-hop-paris.fr
Molinier
L
L
Combescure
C
C
Daurès
J P
JP
Housset
B
B
Vergnenègre
A
A
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000628:therapy*; D018288:Carcinoma, Small Cell / Q000191:economics* / Q000628:therapy*; D003365:Costs and Cost Analysis; D005260:Female; D005602:France; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000628:therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010166:Palliative Care / Q000191:economics