title: A population-based study of the resource utilization and costs of managing resectable non-small cell lung cancer.
abstract: OBJECTIVE
  Surgical resection and adjuvant chemotherapy have become standard of care for treating resectable early stage non-small cell lung cancer (NSCLC). The purpose was to describe and compare the overall and regional resource utilization and costs of resected NSCLC treated with and without adjuvant chemotherapy.
  
  
  METHODS
  A population-based retrospective cohort study of resected NSCLC patients, diagnosed between 2004 and 2006 (representing the cohort immediately affected by the change in clinical practice) was performed using administrative data. Patients were followed for four years from the date of surgery. The healthcare system perspective was used, and cost estimates (2012 US$) were derived from administrative data and the literature.
  
  
  RESULTS
  3354 patients were included. The average cost per patient treated with surgery and adjuvant chemotherapy was $37,860.88 and was significantly higher than the average cost per patient treated with surgery alone $32,221.45 (p<0.0001). Among regions, the costs of patients treated with surgery and chemotherapy ($32,672-$45,453) and the costs of those treated with surgery alone ($28,679-$36,845) varied significantly (p<0.0001). Rates of chemotherapy, the proportion of patients who received any imaging scans, hospitalizations, specialist visits, emergency room visits, mean number of imaging scans, general physician visits, and blood transfusions all varied significantly among geographic regions.
  
  
  CONCLUSIONS
  This population-based study demonstrates an average cost per patient similar to that shown in randomized controlled trials; however, costs for either treatment approach varied by geographic region. Understanding the regional variation in costs and resource utilization is important with respect to delivering optimal treatment in a cost-effective strategy.
authors.affiliation: Department of Public Health Sciences, Queen's University, Ontario, Canada.
authors.forename: Alyson L
authors.initials: AL
authors.lastname: Mahar
authors.affiliation: Institute for Clinical Evaluative Sciences, Ontario, Canada; Odette Cancer Centre, Division of General Surgery, Sunnybrook Health Sciences Centre, Ontario, Canada.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
authors.affiliation: Department of Public Health Sciences, Queen's University, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada; Centre for Health Services and Policy Research, Queen's University, Ontario, Canada. Electronic address: ana.johnson@queensu.ca.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Johnson
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies
keywords: Adjuvant; Chemotherapy; Costs and Cost Analysis; Lung Neoplasms; Physician's Practice Patterns; Resectable Lung Cancer