THE COST OF TREATING SMALL-CELL LUNG-CANCER

Objective: To determine the cost of treating small cell lung cancer (SCLC) and to assess quality-adjusted survival in these patients. Design: Retrospective analysis. Setting: Westmead Hospital, a tertiary referral institution. Patients: Consecutive sample of 31 patients with histologically proved SCLC, treated between January 1987 and December 1987. Main outcome measures: The cost of investigation, hospitalisation, chemotherapy, radiotherapy and follow-up of patients overall and for those with limited and extensive disease respectively. Quality-adjusted survival was based on a Q-TWIST analysis. Results: The median overall cost per patient was $14 413 (range, $1188-$39 598) for all patients and for limited disease and extensive disease was $18 234 (range, $1914-$39 598) and $13 177 (range, $1188-$32 798) respectively. The two major costs were hospitalisation (42%) and chemotherapy (18%). Radiotherapy accounted for 11% of all costs. The Q-TWIST analysis suggests that for patients with limited disease, quality-adjusted survival is similar to absolute survival. Conclusions: The treatment of SCLC at our institution was expensive but the cost may be reduced by reduction in the duration of hospitalisation, the use of less expensive combination drug regimens, or the use of "true" outpatient chemotherapy. Despite intensive therapy, patients with limited disease maintained a reasonable quality of life.