The chemotherapy costs were based on the estimation of the costs used by the HTBS
for the use of chemotherapy in advanced disease (stage III and IV) NSCLC. The chemotherapy
cost was estimated for Cisplatin plus Vinorelbine but using Australian data. The cost
estimation can be seen in Appendix 1. This took data from the Pharmaceutical Benefit
Schedule for Cisplatin and Vinorelbine. The inpatient and outpatient costs were taken from the
literature. A number of assumptions had to be made in calculating the cost with the costs of
drug preparation and administration, side effects and counselling costs all having to be taken
from the UK costs estimates and transferred into Australian dollars.39 To take into account the
high uncertainty over the chemotherapy and radiotherapy costs a two way sensitivity analysis
will be undertaken with the values for both costs being doubled and halved.
If N0/1 M0 patients correctly underwent surgery and survived then they were assumed to be
free from disease and did not undergo anymore direct costs. Patients will undergo a course of
radiotherapy if they are correctly identified as N2/3 M0 patients, and then followed up with a
course of chemotherapy. It is also assumed that 10% of patients with N2/3 undergoing a futile
thoractomy will be identified as such and progress to radical radiotherapy and chemotherapy.
All other patients that undergo a futile thoractomy are assumed to just undergo chemotherapy
because when the disease reappears it is too late to treat it any other way. Those identified as
having M1 disease will undergo palliative care in the form of chemotherapy.
Discounting Costs and Benefits
The majority of cost occurs immediately after or soon after diagnosis. The only patients
that are likely to be affected are the N0/1 M0 patients whose life expectancy are 4.5 years if
successfully operated upon and will receive post operative follow up costs and terminal care
costs. However, there is no firm data on these costs and any speculation on the make up of
these costs would be speculative, therefore a decision was made not to discount costs and
benefits in this model this is consistent with the HTBS and NICE studies.
39 HTBS, “Comment on NICE Technology Appraisal Guidance on the use of Docetaxel and Paclitaxel ,
Gemcitabine and Vinorelbine for the treatment of non small cell lung cancer” 2001B.
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