In other words, we attempt to estimate the utility difference after adjustment for QoL and lead-time bias, which might be regained through future screening initiatives. The Institutional Review Board of the National Cheng Kung University Hospital (NCKUH) approved the study before commencement (ER-100-079), and every interviewed patient provided written, informed consent. We abstracted a NSCLC cohort from the NCKUH database of lung cancer for survival analysis, applied the national life tables to extrapolate the survival function to lifetime, prospectively collected the QoL data from a cross-sectional subsample of the cohort, and integrated the lifetime

survival with the QoL to estimate the QALE and loss-of-QALE of NSCLC patients using the QALY unit. All patients with NSCLC and free from other malignancies during the period from January DAPT purchase 2005 to December

2011 were recruited from the NCKUH lung cancer database. The diagnosis of NSCLC and its pathological subtypes were based on histology or cytology. We defined the tumor stage of each patient by tumor-node-metastasis classifications [9] and [10]. Patients with tumor stages I, II, IIIA, and IIIB were assessed by experienced thoracic surgeons for tumor operability. Subjects who underwent pulmonary resections as the curative treatment were recruited as http://www.selleckchem.com/products/VX-809.html the operable patients, while the others belonged to the inoperable group. The thoracic surgeons decided whether to perform pulmonary resections or not, according to the practice guidelines [11] as well as each patient’s pulmonary reserve and co-morbidities. We used the Eastern Cooperative Oncology Group score to classify the performance status of each patient [12]. The score runs from 0 to 5, with 0 denoting mafosfamide fully active and 1–5 denoting restricted in physical strenuous activity, <50% in bed during the day, >50% in bed, bedbound, and dead, respectively. To avoid selection bias in the operable group, only patients with performance status 0–1 were evaluated, however, a sensitivity

analysis for subjects with performance status 0–4 was also performed. The survival status for each patient was verified by follow-up from the day of diagnosis till the end of 2011. After obtaining the survival function of the cohort through Kaplan–Meier estimate, a method proposed by Huang and Wang was used to extrapolate the survival function beyond the end of the follow-up period [13]. This approach assumed that NSCLC generated a constant excess hazard after the initial follow-up period, and its calculation comprised three steps. First, we borrowed the hazard functions from the life tables of the National Vital Statistics of Taiwan to generate an age- and sex-matched reference population by the Monte Carlo method and estimated its survival function.