Cost effectiveness of evidence-based treatment guidelines for the treatment of non-small-cell lung cancer in the community setting.
OBJECTIVE
The goal of this study was to evaluate the cost-effectiveness of Level I Pathways, a program designed to ensure the delivery of evidence-based care, among patients with non-small-cell lung cancer (NSCLC) treated in the outpatient community setting.


METHODS
We included patients with NSCLC initiating a chemotherapy regimen between July 1, 2006, and December 31, 2007, at eight practices in the US Oncology network. Patients were characterized with respect to age, sex, stage, performance status, and line of therapy and were classified by whether they were treated according to Level I Pathways guidelines. Twelve-month cost of care and overall survival were compared between patients treated on Pathway and off Pathway. A net monetary benefit approach and corresponding cost-effectiveness acceptability curves were used to evaluate the cost-effectiveness of Level I Pathways.


RESULTS
Overall, outpatient costs were 35% lower for on-Pathway versus off-Pathway patients (average 12-month cost, $18,042 v $27,737, respectively). Costs remained significantly less for patients treated on Pathway versus off Pathway in the adjuvant and first-line settings, whereas no difference in overall cost was observed in patients in the second-line setting. No difference in overall survival was observed overall or by line of therapy. In the net monetary benefit analysis, after adjusting for potential confounders, we found that treating patients on Pathway was cost effective across a plausible range of willingness-to-pay thresholds.


CONCLUSIONS
Results of this study suggest that treating patients according to evidence-based guidelines is a cost-effective strategy for delivering care to those with NSCLC.
Kansas City Cancer Center, Overland Park, KS; Texas Oncology, Austin; US Oncology, Houston, TX; New York Oncology Hematology, Albany, NY; Aetna Informatics; and Aetna, Hartford, CT.
Marcus A
MA
Neubauer
J Russell
JR
Hoverman
Michael
M
Kolodziej
Lonny
L
Reisman
Stephen K
SK
Gruschkus
Susan
S
Hoang
Albert A
AA
Alva
Marilyn
M
McArthur
Michael
M
Forsyth
Todd
T
Rothermel
Roy A
RA
Beveridge