Evolution of Diagnoses, Survival, and Costs of Oncological Medical Treatment for Non-Small-Cell Lung Cancer over 20 Years in Osona, Catalonia

Round 1

Reviewer 1 Report

Thank you for giving me the opportunity to read and comment a report “Evolution of diagnoses, survival, and costs of oncological treatment for non-small cell lung cancer over 20 years in Osona-Catalonia.”, by Parera Roig M., et al.

This paper is well written, correctly structured with a suitable research concept, the study limitations are addressed, and it is of relevance to readers of the journal. However, the authors should clarify some methodological aspects:

The manuscript describes an observational study. Did the authors adhere to any methodological guidelines, such as the STROBE or RECORD recommendations? Please clarify this aspect.

What type of price is included in the “CatSalut nomenclator” for hospital drugs? Is it the notified price, PVL, or PVP? Does it include taxes?

The price of medications for hospital use may frequently be subject to discounts and may not correspond with the official nomenclator. Did the authors consider this issue?

Did the authors conduct any statistical tests to assess the normality of the sample? Did the authors assume that the sample follows a normal distribution because of its size?

The authors present cost results using the mean and median. It is recommended to accompany these measures with their corresponding standard deviation or interquartile range.

As a minor issue, according to the journal's instructions, the abstract should be a single paragraph and should follow the style of structured abstracts, but without headings

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

In this paper on epidemiological changes of NSCLC within two decades in central Catalonia the authors summarize single institutional evidence on the diagnostic work-up, survival and costs of oncological medication. Although the article covers only a relatively small region in the north-eastern part of Spain, the data presented here are of interest to the thoracic oncological community since investigations like this may serve as a model for similar analyses. Before publication some aspects merit further consideration.

While the title refers to oncological treatment in general, the contents of the paper does not give any information on radiotherapy or surgery. I suggest that the authors either integrate radiation and surgery data (which would be highly commended) or limit the title to medical oncological treatment only.

Line 26: shift in histopathological subtypes from adenocarcinoma in initial years, to squamous carcinoma. This is completely counter-intuitive and – at least from my understanding- wrong. On top of that it contradicts what is said in section 3.1 (in this section it is described the other way round, eg. In lines 152-153). Please correct.

Lines 148-149: Why does the frequency of stage I diagnosis increase during the past five years? Was a screening program implemented in Spain since 2017 - following the results of the NELSON and NLST trials? Please comment in the discussion section.

Table 1. What do the p-values refer to?

Section 3.3 Survival rates increased dramatically during the past 5 years. Most likely, this has to do with the introduction of immunotherapy in widespread clinical practice. It may also have to do with improved diagnostic work-up including PET as well as better radiation and surgery techniques.  I think this should be appropriately discussed. The fault may well be on my side, but I only found a discussion on the costs of newer systemic agents (lines 285- 299).

Lines 200-202: How do you explain the cost explosion from €1.413 to 48.283 within 15 years? Are these numbers real? I would assume that a 30-fold increase within such a relatively short period of time must lead to a collapse of the public health care system.

Lines 210-211: immunotherapy in monotherapy – does it mean: immunotherapy as monotherapy?

Discussion: Summarize all the relevant results of the paper in the first paragraph. Please shorten the discussion section.

Moderate changes required.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The manuscript is suitable for publication as the authors have addressed all recommendations.

Reviewer 2 Report

No further comments on my part.

Moderate changes required.