The role of adjuvant chemotherapy in stage IB non-small cell lung cancer: A decision, effectiveness, and cost-effectiveness analysis.

8526Background: Despite complete surgical resection (SR), half of stage I non-small cell lung cancer (NSCLC) patients die from systemic relapse. An independent risk factor for systemic progression is pathologic stage IB subtype (T2aN0M0, AJCC 7). The role of adjuvant chemotherapy (AC) in stage IB NSCLC is controversial. We studied the effectiveness and cost-effectiveness of AC after SR in stage IB NSCLC. Methods: Propensity score matching was performed on the National Cancer Database (2004-2011). The Kaplan-Meier method generated conditional probabilistic incremental 1- to 5-year survival after SR stratified by receipt of AC. Medicare allowable charges for SR, AC, and their respective complications were used. Decision analysis modeling and microsimulation were performed to account for proportions of chemotherapeutic agents administered in real-world settings. The incremental cost-effectiveness ratio (ICER) was calculated over a 5-year horizon. Probabilistic and two-way sensitivity analyses were performed....