title: The Role of Surgical Resection in Stage IIIA Non-Small Cell Lung Cancer: A Decision and Cost-Effectiveness Analysis.
abstract: BACKGROUND
  This study evaluated the cost-effectiveness of combination chemotherapy, radiotherapy, and surgical intervention (CRS) vs definitive chemotherapy and radiotherapy (CR) in clinical stage IIIA non-small cell lung cancer (NSCLC) patients at academic and nonacademic centers.
  
  
  METHODS
  Patients with clinical stage IIIA NSCLC receiving CR or CRS from 1998 to 2010 were identified in the National Cancer Data Base. Propensity score matching on patient, tumor, and treatment characteristics was performed. Medicare allowable charges were used for treatment costs. The incremental cost-effectiveness ratio (ICER) was based on probabilistic 5-year survival and calculated as cost per life-year gained.
  
  
  RESULTS
  We identified 5,265 CR and CRS matched patient pairs. Surgical resection imparted an increased effectiveness of 0.83 life-years, with an ICER of $17,618. Among nonacademic centers, 1,634 matched CR and CRS patients demonstrated a benefit with surgical resection of 0.86 life-years gained, for an ICER of $17,124. At academic centers, 3,201 matched CR and CRS patients had increased survival of 0.81 life-years with surgical resection, for an ICER of $18,144. Finally, 3,713 CRS patients were matched between academic and nonacademic centers. Academic center surgical patients had an increased effectiveness of 1.5 months gained and dominated the model with lower surgical cost estimates associated with lower 30-day mortality rates.
  
  
  CONCLUSIONS
  In stage IIIA NSCLC, the selective addition of surgical resection to CR is cost-effective compared with definitive chemoradiation therapy at nonacademic and academic centers. These conclusions are valid over a range of clinically meaningful variations in cost and treatment outcomes.
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Pamela
authors: P
authors: Samson
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Aalok
authors: A
authors: Patel
authors: Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Cliff G
authors: CG
authors: Robinson
authors: Division of Medical Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Daniel
authors: D
authors: Morgensztern
authors: Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Su-Hsin
authors: SH
authors: Chang
authors: Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Graham A
authors: GA
authors: Colditz
authors: Division of Medical Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Saiama
authors: S
authors: Waqar
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Traves D
authors: TD
authors: Crabtree
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: A Sasha
authors: AS
authors: Krupnick
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Daniel
authors: D
authors: Kreisel
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: G Alexander
authors: GA
authors: Patterson
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors: Bryan F
authors: BF
authors: Meyers
authors: Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri. Electronic address: puriv@wudosis.wustl.edu.
authors: Varun
authors: V
authors: Puri
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000191:economics*; D012189:Retrospective Studies