title: An economic analysis of sublobar resection versus thermal ablation for early-stage non-small-cell lung cancer.
abstract: OBJECTIVE
  To compare medical costs for a matched-pair cohort of Medicare patients with early-stage non-small-cell lung cancer (NSCLC) who underwent treatment with sublobar resection or thermal ablation.
  
  
  METHODS
  Patients at least 65 years of age with stage IA/IB NSCLC treated with sublobar resection or thermal ablation from 2007 to 2009 were identified from Surveillance, Epidemiology, and End Results/Medicare-linked data and matched by propensity scores. The primary outcome of interest, cost from the payer's perspective, was derived from Medicare claims data. A partitioned inverse probability-weighted estimator was used to calculate mean and median treatment-related costs and costs at 1, 3, 12, 18, and 24 months after treatment. Baseline characteristics, Kaplan-Meier survival curves, and calculated cost variables were compared between the two groups.
  
  
  RESULTS
  The final matched cohort of 128 patients had similar baseline characteristics and overall survival (P = .52). Patients who underwent ablation had significantly lower treatment-related costs than those who underwent sublobar resection (P < .001). The difference in median treatment-related cost was $16,105. At 1 month, 3 months, and 12 months after treatment, cumulative costs remained significantly different (P ≤ .011). Lower cost associated with ablations performed in the outpatient setting was a major contributor to the differences between the two treatment modalities, although inpatient ablations maintained a small cost advantage over sublobar resections.
  
  
  CONCLUSIONS
  Among matched Medicare patients with stage I NSCLC, thermal ablation resulted in significantly lower treatment-related costs and cumulative medical costs 1 month, 3 months, and 12 months after treatment compared with sublobar resection.
authors.affiliation: Department of Radiology, University of Washington Medical Center 1959 NE Pacific St., Suite 357115, Seattle, WA 98195; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington. Electronic address: shakwan@uw.edu.
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Kwan
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Mortell
authors.affiliation: Department of Radiology, University of Washington Medical Center 1959 NE Pacific St., Suite 357115, Seattle, WA 98195.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: Department of Radiology, William S. Middleton Veterans Administration Hospital and University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Brunner
mesh_terms: D055011:Ablation Techniques / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000191:economics*; D057216:Propensity Score; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States