First, all patients must have performance status 0–1 to be included for analysis and most (86.1%, 446 of 518 patients) of our subjects were recruited from outpatient departments. They were thus less likely to have any severe adverse effects and would have higher utility values [20]. Second, because insight into the diagnosis of lung cancer was one of the inclusion criteria required by the Institutional Review Board, the utility values of our patients would usually be higher [25]. Third, we

assumed that patients remained at the same level of QoL near the end of the follow-up period while extrapolating the QoL function to lifetime. Such an assumption could result in a higher QoL value, because the actual utility value usually declines with age [26]. However, as the life span of lung cancer patients is short and both groups of patients were Epacadostat research buy treated in the same way, the difference between them would not be confounded by this approach. Several limitations must be acknowledged in this study. First, since we used an age- and sex-matched reference population instead of patients with the same comorbidities, the QoL and survival of our patients might be affected by major chronic diseases. Fortunately, Table 1 shows minor differences in the prevalence rates for the

two comparison groups and corresponding cross-sectional subsamples. We further limited the recruitment to those

with performance status 0–1 and free from other malignancies, thus Tacrolimus the results would not be biased too much. Second, QoL measurements from some individuals were performed repeatedly. Nevertheless, as each measurement was taken at least 3 months apart and the results using repeated measurements did not differ from those only including the first QoL measurements, the potential bias would be minimal. Third, the estimation of QALE Teicoplanin would have been more accurate if we had measured the QoL of every patient in the cohort repeatedly during the follow-up period. Unfortunately, we were unable to conduct such a study, and thus used a consecutive, cross-sectional subsample of patients who were healthy enough to accept our invitations for interviews. In conclusion, we successfully estimated the QALE and loss-of-QALE of operable and inoperable NSCLC patients. The lifetime utility gain from surgical operation is 9 QALY after adjusting for QoL and lead-time bias. Future studies may focus on comparing screening programs with treatment strategies to obtain the cost-per-life year and/or cost-per-QALY for technology assessment and possible development of cost-effective clinical guidelines. The authors declare that they have no competing interests. This research was, in part, supported by the Ministry of Education, Taiwan, R.O.C.