Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews
BMC Health Services Research volume 17, Article number: 413 (2017)
Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods.
In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: “lung cancer”, “lung oncology”, “lung Carcinoma”, “lung neoplasm”, “lung tumors”, “cost- effectiveness”, “systematic review” and “Meta-analysis”. The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of “assessment of multiple systematic reviews” (AMSTAR) tool.
Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11.
Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of Discounting will be necessary in the studies.
Nowadays cancer is one of the major health problems all over the world [1,2,3,4]. The lung cancer is one of the most common cancers worldwide and is the major cause of mortality from cancer in the world [5,6,7,8].
In 2008, 1.6 million new cases, and 1.38 million deaths from lung cancer were reported. The highest rates belonged to Europe and North America . Despite the fact that the mortality rate in men has been declining for more than 20 years ago, the mortality rate from lung cancer in women has increased during the past decades, and has stabilized recently [10, 11].
Eastern Europe is accounted for the highest mortality rate from lung cancer in men, while Northern Europe and America have the highest mortality rate among women. In America, black men and women are more affected by the disease . Lung cancer rate is lower in Low and Middle Income Countries (LMICs) . due to increasing in rate of smoking in LMICs, it is expected that the rate increase particularly in China and India in the next few years [14,15,16].
The most common cause of lung cancer is the prolonged exposure to tobacco smoke, which is the reason of 90% of lung cancers [17,18,19,20]. The Percent of lung cancer in people who do not smoke is 15% and the reason is often due to a combination of factors including genetic factors, radon gas, asbestos, and air pollution such as cigarette smoke of another person .
Given the general state of health, evaluation of lung cancer may include: lungs photography with X radiation, sputum tests, CT scan, biopsy, breath testing, blood tests, and bone marrow tests [22,23,24,25,26,27,28]. The most important treatments for lung cancer include: surgery, laser ablation of malignant lesion, chemotherapy, radiation therapy and photodynamic therapy [29,30,31,32,33].
Currently due to rising costs and limited resources on the one hand and high costs of prevention, screening and treatment of chronic diseases, especially cancer on the other hand, Health care providers are looking for the most effective and cost-effective care. For this reason, economic evaluation studies will be used for this purpose. One of the most important studies in this field is the evaluation of the cost-effectiveness . In this type of analysis, it is necessary to determine the costs and consequences of the use of given technologies, which includes estimates about their value. In this type of analysis, outcomes are measured and expressed through natural units (eg number of life years). By doing this analysis, we can determine that which one of the compared technologies are proper to achieve targets [35, 36].
Fortunately, given the sensitivity and importance of lung cancer, a lot of cost-effectiveness studies conducted by different researchers and valid evidence have been produced in this area. In recent years, due to expansion of these studies in each of these areas of expertise related to lung cancer, some studies have also designed and carried out as a systematic review [37,38,39,40,41].
A systematic review of studies provides integrated and reliable information for users of information . Systematic reviews carried out in different domains with different conclusions can confuse the users of these studies. By considering the expansion of these studies and their scattered results, it is needed to collect and report the results of these types of studies as one cohesive and integrated collection. Therefore, the aim of this study was to systematically review systematic review studies which review the cost-effectiveness in various fields related to lung cancer.
This systematic review and Meta-Analysis study was conducted in 2016, using the approach of systematic review adopted from the book entitle “A Systematic Review to Support Evidence-Based Medicine”. Also in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [44,45,46].
The inclusion criteria for the study were: systematic review and Meta-analysis studies on the lung cancer patients, studies conducted on Cost- effectiveness, articles published in English language, and articles published from January 2000 to 2march 2016. Excluded criteria from the study included: articles that report other type of economic studies, articles that conduced only in one country, conference presentations, case reports and narrative reviews. Also articles that had low score based on Assessment of Multiple Systematic Reviews (AMSTAR) checklist were excluded.
Information sources and search strategy
Required data were collected searching the following key words which selected from MeSH: “lung cancer”, “lung oncology”, “lung Carcinoma”, “lung neoplasm”, “lung tumors”, “cost- effectiveness”, “systematic review” and “Meta-analysis”. The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. The complete search strategy for PubMed is shown in Table 1. The search strategy was adapted for each database as necessary. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles also were checked. In the final stage of the literature review we also searched the gray literature and did expert contact.
In the first phase of the review process, an extraction table was designed in which the following items included: first author’s name, study publish year, aim of study, number of all publications included, Meta-Analysis, Time Horizon covered, Quality assessment tool, Screening or treatment, perspective, Discounting, Sensitivity analysis, Incremental analysis and overall result. Validity of the data extraction table was confirmed by experts, and a pilot study was conducted for further improvement of the extraction table. Two authors (RA and A-AS) that had enough experience and knowledge were responsible for independently extraction of the data.
In first phase of article selection, articles with non-relevant titles were excluded. In the second phase, the abstract and the full text of articles were reviewed to include those articles matching the inclusion criteria. Reference management (Endnote X5, Thomson Reuters, and Philadelphia, PA 19130, USA) software was used for organizing and assessing the titles and abstracts, as well as for identifying the duplicate entries.
Two reviewers (RA and A-AS) evaluated the articles according to the checklist of “assessment of multiple systematic reviews” (AMSTAR) tool . Responses of the AMSTAR tool are ‘Yes’, ‘No’, ‘Can’t Answer’, or ‘Not Applicable’, with yes being rated as ‘1’, and ‘no’, ‘can’t answer’, or ‘not applicable’ rated as ‘0’. Based on this tool, reviews were rated as ‘low’ from 1 to 4, ‘moderate’ from 5 to 7 or ‘high’ from 8 to 11 quality. Articles with “low” quality were excluded. Controversy cases between reviewers were referred to a third author (AFA-F).
The retrieved data were briefed in extraction table and finally, for mapping and categorizing the result a manual Content-Analysis was used. This is a method to detecting, categorizing and reporting themes from text and is very useful in analyzing qualitative data [48,49,50,51].
In this study, out of 436 articles, finally 8 articles were completely related to the study objective included in the analysis (Fig 1).
As seen in Fig. 1, 254 articles have been removed due to duplication between databases, 162 articles have been omitted by reviewing their abstracts and 17 papers were excluded by reviewing their full texts. Also In assessing the quality of articles, 8 articles was deleted.
The results of extracted data from entered articles are summarized in Table 2.
In the process of investigating the 8 systematic reviews, information of 110 articles were discussed in total. None of the reviewed studies had used the meta-analysis method. The desired time frame of reviewed papers varied between from 1950 to 2014. The Quality of Health Economic Studies tool (QHES) and Drummond checklist were mostly used in assessing the quality of articles. Authors of the 5 articles from 8 reviewed papers had focused on the cost-effectiveness of lung cancer treatments and authors in 3 other articles were assessing the cost-effectiveness of lung cancer screening methods.
Exclusive information related to the cost-effectiveness (perspective, Discounting, Sensitivity analysis, Incremental analysis and overall result) has been presented in Table 3.
In this study, mentioned perspectives in the studies were classified into four groups: Social, Health, Payer and not reported. Results of repetition of each of the four groups are shown in Fig. 2. As seen in Fig. 2, most perspective was related to the Payer and the lowest belonged to Social. In six studies, the perspective was not reported.
Among 8 reviewed studies, Discounting and Sensitivity analysis weren’t mentioned in two articles and Incremental analysis wasn’t referred to in one study. The frequency distribution of cases referred to the Discounting, Sensitivity analysis and Incremental analysis in110 articles among 8 systematic reviews which were compiled in this study, is shown in Fig. 3. As seen in Fig. 3, most of cases refer to Incremental analysis (in 82% of cases) and the lowest rate of reference belonged to Discounting as well (in 49% of cases).
Results of the Quality Assessment of the entered articles to the study are shown in Table 4. All of the 8 articles which were embodied in the study had high quality and all cases had been regarded in 2 articles (score of 11). Also the average quality score of the articles were evaluated to be high (9.25 out of 11).
Results of the present study indicated that in the eight reviewed systematic reviews, information of 110 papers was summarized. None of the reviewed studies had used the meta-analysis method. The QHES and Drummond checklist were mostly used in assessing the quality of articles. Authors of the 5 articles from 8 reviewed articles had focused on the cost-effectiveness of lung cancer treatments and goal of the researchers in 3 other articles were assessing the cost-effectiveness of methods for screening lung cancer. The most perspective referred to Payer (64 times) and the lowest was related to Social (11 times). Six studies not report the perspective of study. Most cases referred to Incremental analysis (82%) and the lowest rate of reference belonged to Discounting (in 49% of cases). The average quality score of included systematic reviews was calculated 9.2% from 11.
One of the major treatments that were mentioned in numerous studies is the targeted drug therapy. Targeted therapies are newer treatments that work by targeting specific abnormalities in cancer cells. Targeted Therapeutic options for Lung Cancer Treatment include: bevacizumab, Erlotinib and Crizotinib that the cost-effectiveness of this type of therapies in the treatment of lung cancer has been demonstrated in many studies [52,53,54,55,56,57]. Thus, this therapy can be one of the options for decision makers and politicians to choose and use in the clinical settings of their own countries. Although the assessment of the cost-effectiveness of this therapeutic method in the local environment of each country should not be forgotten before choosing this treatment; since the cost-effectiveness of procedures and treatments can vary from one environment to another. Also the results of these kind of studies can be tarnished by many factors such as pharmacy company sponsorship for those undertaking the economic evaluations.
Results of a systematic review by Black, Bagust et al. (2006)  failed to demonstrate the cost-effectiveness of computed tomography (CT) in lung cancer screening. However results of a study by Hanly, Skally et al. (2012)  and Kriza, Emmert et al. (2014) , meanwhile, indicated the cost-effectiveness of this approach in patients with colon cancer. The probable reason for this difference could be the type of computed tomography in these studies, because the computerized tomographic colonography (CTC) had been used in the both studies on colon cancer patients. Thus, it appears that CTC is more cost-effective compared to CT. However, this should be investigated and evaluated in patients with lung cancer.
Although systematic reviews of studies have their own value, their value is appreciably enhanced when combined with meta-analysis methods [61,62,63]. Two possible reasons for not using meta-analysis are discussed in the literature. First scholars do not know how to do it, in which case providing the necessary training on how to perform meta-analysis seems quite necessary. Secondly, methodological and data problems in the process of study do not allow the researchers to carry out the meta-analysis method. To address this problem use of specific guidelines for publication as well as training of scholars about the methods of carrying out a high quality research can have considerable results.
According to the study results, among various assessment tools, QHES and Drummond checklist were mostly used in assessing the quality of articles. QHES designed by Chiou and colleagues in 2003 in America and consists of 16 questions . Drummond checklist contains 35 questions in three sections: Study design (7 questions), Data collection (14 questions) and Analysis and interpretation of results (14 questions) . Due to the comprehensiveness and applicability of these tools in assessing the quality of economic evaluation studies, Psychometric of these tools and using them in different countries are recommended.
Based on results of the study, among existing perspectives, perspective of community had the lowest references in the studies. In addition, it should be noted that cancer imposes considerable cost to the health care system and third-party payers. As a matter of fact, cancer imposes a lot of direct and indirect financial and psychological costs to community and families [66,67,68,69,70,71]. According to findings of a study by Bradley et al. (2008) in United States, mortality due to lung cancer accounted about 27% of productivity costs . One of the possible reasons for comparatively little attention of researchers to the perspective of community is difficulties in calculating costs in this method. The possible reason for these difficulties and problems can be mainly derived from the unavailability of data and the difficulties of collecting data in this area compared with the perspective of health system and third-party payers [73,74,75]. Hence, designing a community-based information system for efficiently and effectively collection of the community-level information seems necessary.
Between Discounting, Sensitivity analysis and Incremental analysis, the lowest rate of reference was respectively estimated to be for Discounting (43%). Given the importance of this topic in economic evaluations, failure in attention to this issue can distort the results of economic evaluations and reduce the applicability of the results [76,77,78,79,80,81].
Discounting rate was also reported lower than the Sensitivity analysis and Incremental analysis, in a systematic review by Leung, Chan et al. (2013)  which evaluated the cost-effectiveness of pharmaceutical therapies for metastatic colorectal cancer (MCRC). Discounting is a method to estimate the present value or the current value of cash flows, which are available at a specific time sequence in the future . One of the reasons for paying less attention to the discounting may be its nature, because “future time” is the main factor in the calculation of this index. Also due to considerable uncertainty about the future in the healthcare system compared with the other sectors, the calculation of this index is difficult and unreliable. Another possible reason that can be cited in this context is that despite the interest of scientists in this issue, they may neglect in reporting this index in the article or the scholars who conducted systematic reviews may be wrong in the process of extracting information.
. In current study due to existing defriends in report of studies results and some methodological issue, we cannot conduct Meta-Analysis. Errors may be occurred in the extraction and analysis of the results of this systematic review as it is possible in the other studies. It is noteworthy that most efforts have been made to apply highest possible accuracy in extracting and analyzing data in this study.
The results showed that the targeted therapy options (bevacizumab, Erlotinib and Crizotinib) can be an option for treatment of lung cancer. Evaluation of the cost-effectiveness of the computerized tomographic colonography (CTC) in lung cancer screening is recommended. Use of meta-analysis techniques is required in this field. Psychometric of Drummond checklist and The QHES is recommended in different countries. Perspective of community should be taken into consideration in cost-effectiveness evaluation studies. Paying more attention to the topic of Discounting will be necessary in future researches.
Baudendistel I, Winkler EC, Kamradt M, Brophy S, Langst G, Eckrich F, et al. Cross-sectoral cancer care: views from patients and health care professionals regarding a personal electronic health record. Eur J Cancer Care. 2016;3(10):12429.
Azami-Aghdash S, Ghojazadeh M, Sheyklo SG, Daemi A, Kolahdouzan K, Mohseni M, et al. Breast Cancer Screening Barriers from the Womans Perspective: a Meta-synthesis. Asian Pac J Cancer Prev. 2015;16(8):3463–71.
Murphy KM, Nguyen V, Shin K, Sebastian-Deutsch A, Frieden L. Health Care Professionals and the Employment-Related Needs of Cancer Survivors. J Occup Rehabil. 2016;8:8.
Maleki D, Ghojazadeh M, Mahmoudi SS, Mahmoudi SM, Pournaghi-Azar F, Torab A, et al. Epidemiology of Oral Cancer in Iran: a Systematic Review. Asian Pac J Cancer Prev. 2015;16(13):5427–32.
Fabre Ballalai Ferraz A, Rosim R, Anaya P. Standardization Process Of Raw Datasus And Consumption Analysis Of Oncology Therapies In The Brazil Public Health Care System: A Comparison Between Raw And Standardized Dataset In Colorectal And Lung Cancer. Value Health. 2015;18(7):20.
Faris N, Yu X, Sareen S, Signore RS, McHugh LM, Roark K, et al. Preoperative Evaluation of Lung Cancer in a Community Health Care Setting. Ann Thorac Surg. 2015;100(2):394–400.
Ryoo JJ, Malin JL, Ordin DL, Oishi SM, Kim B, Asch SM, et al. Facility characteristics and quality of lung cancer care in an integrated health care system. J Thorac Oncol. 2014;9(4):447–55.
Sundaram B, Kazerooni EA. Preface. Lung cancer is an important public health care issue. Radiol Clin N Am. 2012;50(5):009.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.
Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, et al. Cancer statistics, 2004. CA Cancer J Clin. 2004;54(1):8–29.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57(1):43–66.
Black M, Mooney G. Equity in health care from a communitarian standpoint. Health Care Anal. 2002;10(2):193–208.
Van Lerberghe W. The world health report 2008: primary health care: now more than ever: World Health Organization; 2008.
Zhang J, Ou JX, Bai CX. Tobacco smoking in China: prevalence, disease burden, challenges and future strategies. Respirology. 2011;16(8):1165–72.
Hasan AN, Ahmad MW, Madar IH, Grace BL, Hasan TN. An in silico analytical study of lung cancer and smokers datasets from gene expression omnibus (GEO) for prediction of differentially expressed genes. Bioinformation. 2015;11(5):229–35.
Phukan RK, Borah PK, Saikia BJ, Das M, Sekhon GS, Mahanta J. Interaction of tobacco smoking and chewing with Angiotensin converting enzyme (insertion/deletion) gene polymorphisms and risk of lung cancer in a high risk area from northeast India. Asian Pac J Cancer Prev. 2014;15(24):10691–5.
Hirano H, Maeda H, Yamaguchi T, Yokota S, Mori M, Sakoda S. Survivin expression in lung cancer: Association with smoking, histological types and pathological stages. Oncol Lett. 2015;10(3):1456–62.
Huang R, Wei Y, Hung RJ, Liu G, Su L, Zhang R, et al. Associated Links Among Smoking, Chronic Obstructive Pulmonary Disease, and Small Cell Lung Cancer: A Pooled Analysis in the International Lung Cancer Consortium. EBioMedicine. 2015;2(11):1677–85.
Yu YW, Wang CP, Han YF, Niu JJ, Zhang YZ, Fang Y. Meta-analysis on related risk factors regarding lung cancer in non-smoking Chinese women. Zhonghua Liu Xing Bing Xue Za Zhi. 2016;37(2):268–72.
Yun YD, Back JH, Ghang H, Jee SH, Kim Y, Lee SM, et al. Hazard Ratio of Smoking on Lung Cancer in Korea According to Histological Type and Gender. Lung. 2015;31:31.
Thun MJ, Hannan LM, Adams-Campbell LL, Boffetta P, Buring JE, Feskanich D, et al. Lung cancer occurrence in never-smokers: an analysis of 13 cohorts and 22 cancer registry studies. PLoS Med. 2008;5(9):9.
Hou J, Wang H, Zhang G, Ma Z. Diagnosis and Treatment of Multiple Primary Lung Cancer. Zhongguo Fei Ai Za Zhi. 2015;18(12):764–9.
Luo W, Zhou P, Li W. Advances in Diagnosis and Treatment of Multiple Primary Lung Cancer. Zhongguo Fei Ai Za Zhi. 2015;18(10):640–3.
Makinson A, Eymard-Duvernay S, Raffi F, Abgrall S, Bommart S, Zucman D, et al. Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers. AIDS. 2016;30(4):573–82.
Namazi H, Kiminezhadmalaie M. Diagnosis of Lung Cancer by Fractal Analysis of Damaged DNA. Comput Math Methods Med. 2015;242695(10):11.
Strambu IR, Serbescu A, Leonte DG, Cordos I, Dobre V. Tissue prints for the rapid diagnosis of malignancy in lung cancer. Romanian J Morphol Embryol. 2015;56(4):1423–8.
Tian HY, Xu D, Liu JP, Mao WM, Chen LY, Yang C, et al. Contribution of ultrasound-guided fine-needle aspiration cell blocks of metastatic supraclavicular lymph nodes to the diagnosis of lung cancer. J Cancer Res Ther. 2015;11(8):0973–1482.
Zhi XY, Yu JM, Shi YK. Chinese guidelines on the diagnosis and treatment of primary lung cancer (2015 version). Cancer. 2015;17:3165–81.
Leigh A, Jencks C, Smeeding T, Salverda WNB, Smeeding TM. Health and economic inequality, The Oxford Handbook of Economic Inequality; 2009. p. 384–405.
Du L, Pennell NA, Elson P, Hashemi-Sadraei N. Lung cancer treatment outcomes in recipients of lung transplant. Transl Lung Cancer Res. 2015;4(6):784–91.
Haque W, Szeja S, Tann A, Kalra S, Teh BS. Changes in Treatment Patterns and Overall Survival in Patients With Early-Stage Non-Small Cell Lung Cancer in the United States After the Incorporation of Stereotactic Ablative Radiation Therapy: A Population-based Analysis. Am J Clin Oncol. 2016;14:14.
Subotic D, Van Schil P, Grigoriu B. Optimising treatment for post-operative lung cancer recurrence. Eur Respir J. 2016 Feb;47(2):374–8. doi:10.1183/13993003.01490-2015.
Sullivan I, Planchard D. Treatment modalities for advanced ALK-rearranged non-small-cell lung cancer. Future Oncol. 2016;19:19.
Roudsari B, McWilliams J, Bresnahan B, Padia S. Introduction to Cost Analysis in IR: Challenges and Opportunities. J Vasc Interv Radiol. 2016;25(15):02009–6.
Ebadifard Azar F, Rezapoor A. Health care economics. 1st ed. Tehran: Ebadifar; 2010.
Ebadifard Azar F, Rezapoor A. Health care Financial management. 1st ed. Tehran: Ebadifar; 2012.
Westwood M, Joore M, Whiting P, van Asselt T, Ramaekers B, Armstrong N, et al. Epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation testing in adults with locally advanced or metastatic non-small cell lung cancer: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2014;18(32).
Mohan HK, Miles KA. Cost-effectiveness of 99mTc-sestamibi in predicting response to chemotherapy in patients with lung cancer: systematic review and meta-analysis. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2009;50(3):376–81.
Clegg A, Scott DA, Sidhu M, Hewitson P, Waugh N. Clinical and cost effectiveness of paclitaxel, docetaxel, gemcitabine, and vinorelbine in non-small cell lung cancer: a systematic review. Health Technol Assess. 2001;5(32):1–195.
Ferguson MK. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of paclitaxel, docetaxel, gemcitabine and vinorelbine in non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2003;126(6):1935–42.
Goulart BH, Bensink ME, Mummy DG, Ramsey SD. Cost effectiveness of treatment with new agents in advanced non-small-cell lung cancer: a systematic review. J Natl Compr Cancer Netw. 2012;10(2):267–75.
Boluyt N, Tjosvold L, Lefebvre C, Klassen TP, Offringa M. Usefulness of systematic review search strategies in finding child health systematic reviews in MEDLINE. Arch Pediatr Adolesc Med. 2008;162(2):111–6.
S Khan K, Kunz R, Kleijnen J, Antes G. In: MazurekMelnyk B, editor. Systematic reviews to support evidence-based medicine; 2011.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):21.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009;3(3):21.
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7(1):10.
Campos CJ. Content analysis: a qualitative data analysis tool in health care. Rev Bras Enferm. 2004;57(5):611–4.
Liamputtong P. Qualitative data analysis: conceptual and practical considerations. Health Promot J Austr. 2009;20(2):133–9.
Seers K. Qualitative data analysis. Evid Based Nurs. 2012;15(1):100352.
Smith J, Firth J. Qualitative data analysis: the framework approach. Nurse Res. 2011;18(2):52–62.
Wang S, Peng L, Li J, Zeng X, Ouyang L, Tan C, et al. A trial-based cost-effectiveness analysis of erlotinib alone versus platinum-based doublet chemotherapy as first-line therapy for Eastern Asian nonsquamous non-small-cell lung cancer. PLoS One. 2013;8(3):8.
Vergnenegre A, Ray JA, Chouaid C, Grossi F, Bischoff HG, Heigener DF, et al. Cross-market cost-effectiveness analysis of erlotinib as first-line maintenance treatment for patients with stable non-small cell lung cancer. Clinicoecon Outcomes Res. 2012;4:31–7.
Walleser S, Ray J, Bischoff H, Vergnenegre A, Rosery H, Chouaid C, et al. Maintenance erlotinib in advanced nonsmall cell lung cancer: cost-effectiveness in EGFR wild-type across Europe. Clinicoecon Outcomes Res. 2012;4:269–75.
Araujo A, Parente B, Sotto-Mayor R, Teixeira E, Almodovar T, Barata F, et al. An economic analysis of erlotinib, docetaxel, pemetrexed and best supportive care as second or third line treatment of non-small cell lung cancer. Rev Port Pneumol. 2008;14(6):803–27.
Giuliani G, Grossi F, de Marinis F, Walzer S. Cost-effectiveness analysis of bevacizumab versus pemetrexed for advanced non-squamous NSCLC in Italy. Lung Cancer. 2010;69(1):70133–1.
Ahn MJ, Tsai CM, Hsia TC, Wright E, Chang JW, Kim HT, et al. Cost-effectiveness of bevacizumab-based therapy versus cisplatin plus pemetrexed for the first-line treatment of advanced non-squamous NSCLC in Korea and Taiwan. Asia Pac J Clin Oncol. 2011;2:22–33.
Black C, Bagust A, Boland A, Walker S, McLeod C, De Verteuil R, et al. The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews. Health Technol Assess. 2006;10(3):1–90.
Hanly P, Skally M, Fenlon H, Sharp L. Cost-effectiveness of computed tomography colonography in colorectal cancer screening: a systematic review. Int J Technol Assess Health Care. 2012;28(4):415–23.
Kriza C, Emmert M, Wahlster P, Niederlander C, Kolominsky-Rabas P. An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: is the tide changing due to adherence? Eur J Health Econ. 2014;15(8):801–12.
Haidich AB. Meta-analysis in medical research. Hippokratia. 2010;14(Suppl 1):29–37.
Freemantle N, Geddes J. Understanding and interpreting systematic reviews and meta-analyses. Part 2: meta-analyses. Evidence Based Mental Health. 1998;1(4):102–4.
Garg AX, Hackam D, Tonelli M. Systematic Review and Meta-analysis: When One Study Is Just not Enough. Clin J Am Soc Nephrol. 2008;3(1):253–60.
Chiou CF, Hay JW, Wallace JF, Bloom BS, Neumann PJ, Sullivan SD, et al. Development and validation of a grading system for the quality of cost-effectiveness studies. Med Care. 2003;41(1):32–44.
Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ. 1996;313(7052):275–83.
Kumar P, Moy B. The cost of cancer care--balancing our duties to patients versus society: are they mutually exclusive? Oncologist. 2013;18(4):347–9. doi:10.1634/theoncologist.2013-0078. Epub 2013 Apr 8.
Meropol NJ, Schrag D, Smith TJ, Mulvey TM, Langdon RM Jr, Blum D, et al. American Society of Clinical Oncology guidance statement: the cost of cancer care. J Clin Oncol. 2009;27(23):3868–74.
Eagle D. The cost of cancer care: Part II. Oncology. 2012;26(11):1104–8.
The Lancet H. Counting the cost of cancer treatment. Lancet Haematol. 2015;2(7):e267. doi:10.1016/S2352-3026(15)00117-9.
Trueland J. The cost of cancer. Nurs Stand. 2012;27(7):20–1.
Ward RL, Laaksonen MA, van Gool K, Pearson SA, Daniels B, Bastick P, et al. Cost of cancer care for patients undergoing chemotherapy: The Elements of Cancer Care study. Asia Pac J Clin Oncol. 2015;11(2):178–86.
Bradley CJ, Yabroff KR, Dahman B, Feuer EJ, Mariotto A, Brown ML. Productivity costs of cancer mortality in the United States: 2000-2020. J Natl Cancer Inst. 2008;100(24):1763–70.
Russell LB, Fryback DG, Sonnenberg FA. Is the societal perspective in cost-effectiveness analysis useful for decision makers? Jt Comm J Qual Improv. 1999;25(9):447–54.
Cohen DJ. Economics and cost-effectiveness in evaluating the value of cardiovascular therapies. Evaluation of the cost-effectiveness of coronary stenting: a societal perspective. Am Heart J. 1999;137(5):S133–7.
Meltzer D, Johannesson M. Inconsistencies in the "societal perspective" on costs of the Panel on Cost-Effectiveness in Health and Medicine. Med Decis Mak. 1999;19(4):371–7.
Claxton K, Sculpher M, Culyer A, McCabe C, Briggs A, Akehurst R, et al. Discounting and cost-effectiveness in NICE - stepping back to sort out a confusion. Health Econ. 2006;15(1):1–4.
Jit M, Mibei W. Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review. Vaccine. 2015;33(32):3788–94.
Tinghog G. Discounting, preferences, and paternalism in cost-effectiveness analysis. Health Care Anal. 2012;20(3):297–318.
Starkie Camejo H, Li X, Van Kriekinge G. Does it matter? Discounting and its role in the cost-effectiveness of preventative interventions. The case of HPV vaccination. Public Health. 2015;129(7):989–92.
Westra TA, Parouty MB, Wilschut JC, Boersma C, Postma MJ. Practical implications of differential discounting of costs and health effects in cost-effectiveness analysis. Value Health. 2011;14(8):1173–1174; author reply 1174-5. doi:10.1016/j.jval.2011.07.013.
Polinder S, Meerding WJ, van Exel J, Brouwer W. Societal discounting of health effects in cost-effectiveness analyses: the influence of life expectancy. PharmacoEconomics. 2005;23(8):791–802.
Leung HW, Chan AL, Leung MS, Lu CL. Systematic review and quality assessment of cost-effectiveness analysis of pharmaceutical therapies for advanced colorectal cancer. Ann Pharmacother. 2013;47(4):506–18.
"Time Value", "Discount", "Discount Yield", "Compound Interest", "Efficient Market", "Market Value" and "Opportunity Cost" in Downes, J. and Goodman, J. E. Dictionary of Finance and Investment Terms, Baron's Financial Guides, 2003.
Clegg A, Scott D, Sidhu M, Hewitson P, Waugh N. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of paclitaxel, docetaxel, gemcitabine and vinorelbine in non-small-cell lung cancer. Health Technol Assess. 2001;5(32):1–209.
Lange A, Prenzler A, Frank M, Golpon H, Welte T, von der Schulenburg JM. A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC). BMC Pulm Med. 2014;14(192):1471–2466.
Bongers ML, Coupe VM, Jansma EP, Smit EF, Uyl-de Groot CA. Cost effectiveness of treatment with new agents in advanced non-small-cell lung cancer: a systematic review. PharmacoEconomics. 2012;30(1):17–34.
Raymakers AJ, Mayo J, Lam S, FitzGerald JM, Whitehurst DG, Lynd LD. Cost-Effectiveness Analyses of Lung Cancer Screening Strategies Using Low-Dose Computed Tomography: a Systematic Review. Appl Health Econ Health Policy. 2016;12:12.
Maher AR, Miake-Lye IM, Beroes JM, Shekelle PG. VA Evidence-based Synthesis Program Reports. Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness. Washington: Department of Veterans Affairs (US); 2012.
Brown T, Pilkington G, Bagust A, Boland A, Oyee J, Tudur Smith C, et al. Clinical effectiveness and cost-effectiveness of first-line chemotherapy for adult patients with locally advanced or metastatic non-small cell lung cancer: a systematic review and economic evaluation. Health Technol Assess. 2013;17(31):1–302.
Cao JQ, Rodrigues GB, Louie AV, Zaric GS. Systematic review of the cost-effectiveness of positron-emission tomography in staging of non--small-cell lung cancer and management of solitary pulmonary nodules. Clin Lung Cancer. 2012;13(3):161–70.
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EA,F. AA,S. carried out the search, EN.RA carried out data extraction and analyzing. AA,S. AA,S. PE.RA drafted the manuscript. All authors read and approved the final manuscript
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Azar, F.E., Azami-Aghdash, S., Pournaghi-Azar, F. et al. Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews. BMC Health Serv Res 17, 413 (2017). https://doi.org/10.1186/s12913-017-2374-1
- Lung cancer
- Systematic review