OBJECTIVE: Based on cost-effectiveness analysis

to probe into the economical efficiency of neoadjuvant chemotherapy combined with surgery and surgery alone in the treatment of advanced esophageal cancer. METHODS: Totally 451 patients with esophageal squamous cell carcinoma in the clinical stages of T1-4 N1 M0/T4 N0 M0

treated in 8 hospitals including Sichuan Cancer Hospital from Jun. 2007 to Dec. 2014

were divided into research group and control group via stratified random. The control group（227 cases） was given surgery alone

while the research group（224 cases） was given neoadjuvant chemotherapy combined with surgery. According to the disease progression of esophageal cancer

the disease was divided into three states

namely disease-free state

recurrence/metastasis state and death state

so that the Markov model was established to evaluate the economical efficiency of the two treatment regimens. RESULTS: The model run for 10 years showed that the cost of regimens of surgery alone and neoadjuvant chemotherapy combined with surgery for esophageal cancer were 578 334.18 yuan and 1 024 119.63 yuan

respectively. The incremental cost-effectiveness ratio of neoadjuvant chemotherapy combined with surgical regimen for esophageal cancer was 19 209.26 yuan/QALY. CONCLUSIONS: The incremental cost-effectiveness ratio of neoadjuvant chemotherapy combined with surgery regimen was 19 209.26 yuan/QALY

which is much lower than the willingness-to-pay threshold of 55 774 yuan/QALY in Sichuan Province in 2019. Therefore

neoadjuvant chemotherapy combined with surgery regimen has a significant cost-effectiveness advantage.