Testing strategies of immunotesting first, with FISH after, or FISH

21% of futile thoracotomies vs. 41% with CWU; avoided 1 in 5; cost saving

OS similar; no differences except P + G, cost 25% more

60% reduction in cost of care compared to usual care, health outcomes similar

Relative risk of death reduced to 0.69; adds 0.29 LY at $24,900/LY

Combination gives additional 3 months at cost of $3,700/LY (Canadian)

Increased OS by 19.3 months, cost-effectiveness $13,000-$64,000/LY (Can)

Pain control achieved at 1 month in 80%, 55%, and 30%, respectively ICE for guideline-based care $452/patient.

All dominant strategies over $100,000/LY

PET scan improves preop screening, lowers costs

No advantage, higher cost for nonplatinum combinations

Inpatient palliative care units may improve care at less cost

Cost-effectiveness ratio acceptable

Cost-effectiveness ratio acceptable; with improved survival, utility not likely to be important; trial did not have Capecitabine -alone arm for comparison, or test sequential therapy Co st-effe ctivene ss acceptable under best and worst case scenarios

Acceptable cost per outcome using guidelines to improve pain control

Authors suggest if society willing to pay for trastuzamab, should be willing to pay for optimal testing; avoids question of whether trastuzamab cost-effectiveness is acceptable

CWU, conventional workup; NSCLC, non small cell lung cancer; P paclitaxel; G. gemcitabine; NA, not available; NS, not stated; DA, decision analysis; FISH, fluorescence in situ hybridization; ICE, ifosfamide (Ifex®), carboplatin (Paraplatin®), and etoposide (VP-16, VePesid®).

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