Abstract
Introduction There is a critical need to understand the optimal treatment regimen in patients with potentially resectable stage III-N2 non-small cell lung cancer (NSCLC).
Methods A systematic review of randomised controlled trials using a literature search including the CDSR, CENTRAL, DARE, HTA, EMBASE and MEDLINE bibliographic databases. Selected trials were used to perform a Bayesian fixed effects network meta-analysis and economic modelling of treatment regimens relevant to current day treatment options: chemotherapy plus surgery (CS), chemotherapy plus radiotherapy (CR) and chemoradiotherapy followed by surgery (CRS).
Findings Six trials were prioritised for evidence synthesis. The fixed effects network meta-analyses demonstrated an improvement in Disease-Free Survival (DFS) for CRS versus CS and CRS versus CR of 0.34 years (95% CI 0.02–0.65) and 0.32 years (95% CI 0.05–0.58) respectively, over a five-year period. No evidence of effect were observed in overall survival although point estimates favoured CRS. The probabilities that CRS had a greater average survival time and greater probability of being alive than the reference treatment of CR 5 years were 89% and 86% respectively. Survival outcomes for CR and CS were essentially equivalent. The economic model calculated that CRS and CS had ICERs of £19 000/QALY and £78 000/QALY compared to CR. The probability that CRS generated more QALYs than CR and CS was 94%.
Interpretation CRS provides an extended time in a disease-free state leading to improved cost-effectiveness over CR and CS in potentially resectable stage III-N2 NSCLC.
Footnotes
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Conflicts of interest: RM currently works as Associate Director, Value, Access and Devolved Nations, Merck, Sharp and Dohme (UK) Ltd. During the time of this work his role was Technical Adviser, Centre for Guidelines, National Institute for Health and Care Excellence. MSD market treatments for lung cancer but this work was completed entirely while in employment with NICE and there are no obvious COI related to MSD's activities.
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- Received June 21, 2022.
- Accepted December 20, 2022.
- Copyright ©The authors 2023
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