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Background: In the absence of evidence on whether neoadjuvant or adjuvant chemotherapy is more beneficial for various tumor treatments, economic evaluation 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 help compare these therapies from various perspectives.Methods: 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. Results: The retrieval identified 15 economic evaluation studies of neoadjuvant and adjuvant chemotherapy in eight types of cancer. Neoadjuvant chemotherapy is the dominant strategy for pancreatic, head and neck, rectal, prostate, and cervical cancers, and colorectal liver metastases. For ovarian cancer, neoadjuvant chemotherapy is cost-effective with a lower cost and higher or similar quality-adjusted life year. There were no significant differences between the therapies in cost and outcomes for lung cancer. For stage IV or high-risk patients with ovarian or prostate cancer, neoadjuvant chemotherapy was cost-effective but not for patients who were not high risk.Conclusion: The economic evaluation results of the included studies were inconsistent because of their different model structures, assumptions, cost inclusions, and a shortage of studies. The proportion of the high-risk study population, such as stage IV, age ≥ 70 years, and comorbidity was consistent in some types of cancer. |
