Abstract

Objective: the significant survival benefit of chemotherapy over best supportive care for locally advanced or metastatic nScLc has been amply demonstrated in the literature. however, there is no clear evidence of the impact of chemotherapy prescription and costs on survival time. the present study examines the real-life impact of chemotherapy prescription and costs on overall survival in locally advanced or metastatic nScLc, in order to guide medical decision-making. methods: data were retrospectively collected from the records of 173 patients treated between 2000 and 2004 at Léon Bérard regional cancer centre (Lyon, France). econometric analyses took into account bidirectional interactions between chemotherapy attributes (prescriptions, costs) and survival rates. Survival data were modelled using multivariate cox models, in which the potential endogeneity issue of chemotherapy attributes was adequately addressed by the instrumental variable approach. results: the median survival for the whole cohort was 285 days. the average total cost of chemotherapy drugs reached 5167€ (Sd 6675€). all other things being equal, survival time was not affected by the cost of the chemotherapy drugs administered (p=0.35). however, higher numbers of chemotherapy drugs were associated with increased survival time (p=0.001). Survival was significantly shorter for patients with stage iv compared to stage iiiB (p<0.01), and for patients with past or concomitant cardiovascular and/or diabetic co-morbidities (p<0.01). conclusion: Providing brief cytotoxic treatments in order to maintain as much quality of life as possible, and tailoring therapy to stage and comorbidities could be the less bad choice.

Key-words:

cost, econometrics, nScLc, Survival