Economic Evaluation of Neoadjuvant Versus Adjuvant Chemotherapy in Cancer Treatment: A Systematic Review and Meta-Analysis

• Published in: Value in health regional issues 2024-05, Vol.41, p.15-24
• Main Authors: Wu, Dongdong, Wang, Na, Xu, Rufu, Huang, Guoqiong, Li, Ying, Huang, Chunji
• Format: Article
• Language: English
• Subjects: adjuvant chemotherapy; cancer treatment; Chemotherapy, Adjuvant - economics; Chemotherapy, Adjuvant - methods; Cost-Benefit Analysis - methods; economic evaluation; Humans; neoadjuvant chemotherapy; Neoadjuvant Therapy - economics; Neoadjuvant Therapy - methods; Neoadjuvant Therapy - standards; Neoadjuvant Therapy - statistics & numerical data; Neoplasms - drug therapy; Neoplasms - economics; surgery
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2023.11.005

In the absence of evidence on whether neoadjuvant (NAC) or adjuvant chemotherapy (AC) is more beneficial for various tumor treatments, economic evaluation (EE) can assist medical decision making. There is limited evidence on their cost-effectiveness and their prospective evaluation is less likely in the future. Therefore, a systematic review and meta-analysis about EE for NAC versus AC in solid tumor help compare these therapies from various perspectives. Various databases were searched for studies published from inception to 2021. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and economic-specific guidelines. The data were pooled using a random effects model when possible. The retrieval identified 15 EE studies of NAC versus AC in 8 types of cancer. NAC is the dominant strategy for pancreatic, head and neck, rectal, prostate cancers and colorectal liver metastases. For ovarian cancer, NAC is cost-effective with a lower cost and higher or similar quality-adjusted life-year. There were no significant differences in cost and outcomes for lung cancer. For stage IV or high-risk patients with ovarian or prostate cancer, NAC was cost-effective but not for patients who were not high risk. The EEs results for NAC versus AC were inconsistent because of their different model structures, assumptions, cost inclusions, and a shortage of studies. There are multiple sources of heterogeneity across EEs evidence synthesis. More high-quality EE studies on NAC versus AC in initial cancer treatment are necessary. •Current efficacy and economic evidence on neoadjuvant and adjuvant chemotherapy regimen in initial cancer treatment are summarized.•The flexible framework provided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to incorporate economic-specific guidelines for quality assessments and results’ analyses.•With some cancers, the higher the proportion of a high-risk study population, such as stage IV, age ≥70 years, and comorbidity, the more cost-effective neoadjuvant chemotherapy was.•More high-quality economic evaluation studies and preoperative assessments in initial cancer treatment would enhance the value of medical decisions.