2019年，英国国家卫生与医疗保健卓越研究所（NICE）根据委员会专家的发布数据和建模假设，利用分析成本效益模型更新了关于非小细胞肺癌（NSCLC）脑成像分期的推荐。本研究旨在使用真实的英国多中心数据重新运行此模型。回顾性数据收集了2018年1月1日至12月31日期间十一个急性NHS信托基本治疗临床II、III期肺癌患者的连续数据。在书面申请NICE肺癌指南委员会后，我们获准访问NG122脑成像经济模型，以便根据这项研究的真实世界结果更新输入参数。共分析了444名患者的数据。在II期和III期中，隐匿性脑转移瘤的总患病率分别为6.2％（10 / 165）和6.0％（17 / 283），而NICE经济模型中的患病率为9.5％和9.3％。 有临床III期NSCLC和预治疗成像中隐匿BM的患者中有30％完成了预定的局部治愈治疗，60％完成了脑SRS并有30％完成了WBRT。这与NICE的假设相比为0％，10％和0％。卫生经济学分析得出结论：在II期疾病中，脑成像不再具有成本效益（ICERs为£50,023-£115,785），而对于III期患者，脑成像仍然具有成本效益（ICERs 17,000- £22,173），MRI是最具成本效益的策略。这种基于真实世界数据的NICE卫生经济模型的重新运行强烈支持NICE指南在治疗III期肺癌前进行脑成像的推荐，但对于治疗II期肺癌前进行CT脑成像的成本效益提出了疑问。版权所有©2023 Elsevier B.V. 。保留所有权利。

In 2019, the National Institute for Health and Care Excellence (NICE) updated their recommendations with respect to brain imaging in the staging of non-small cell lung cancer (NSCLC) based on an analytic cost-effectiveness model using published data and modelling assumptions from committee experts. In this study, we aimed to re-run this model using real-world multi-centre UK data.Retrospective data was collected on consecutive patients with radically treatable clinical stage II and III lung cancer from eleven acute NHS Trusts during the calendar year 01/01/2018 to 31/12/2018. Following a written application to the NICE lung cancer guideline committee, we were granted access to the NG122 brain imaging economic model for the purpose of updating the input parameters in line with the real-world findings from this study.A total of 444 patients had data for analysis. The combined prevalence of occult brain metastases was 6.2% (10/165) in stage II and 6% (17/283) in stage III, compared to 9.5% and 9.3% used in the NICE economic model. 30% of patients with clinical stage III NSCLC and occult BMs on pre-treatment imaging went onto complete the planned curative intent treatment of extracranial disease, 60% completed SRS to the brain and 30% completed WBRT. This compares to 0%, 10% and 0% in the NICE assumptions. The health economic analysis concluded that brain imaging was no longer cost-effective in stage II disease (ICERs £50,023-£115,785) whilst brain imaging remained cost-effective for stage III patients (ICERs 17,000-£22,173), with MRI being the most cost-effective strategy.This re-running of the NICE health economic model with real-world data strongly supports the NICE guideline recommendation for brain imaging prior to curative-intent treatment in stage III lung cancer but questions the cost-effectiveness of CT brain imaging prior to curative-intent treatment in stage II lung cancer.Copyright © 2023 Elsevier B.V. All rights reserved.