Surgery versus SABR for resectable non-small-cell lung cancer - Part 8 of 9

This is a letter in response to the article by Chang and colleagues. The authors state that this type of analysis was necessary as it is difficult to conduct a clinical trial that involves new technology. The National Health Service (NHS) England has funded SABR for patients with a variety of malignancies as part of a Commissioning through Evaluation (CtE) programme. The concept of this program is that patients should have access to promising new therapies and this type of funding model allows for the evaluation of these therapies which in turn informs commissioning. The CtE model advantages are: 1) small numbers of patients can provide enough data to answer certain questions, 2) recruitment may be easier as there is no comparision group, 3) highly specialized new technology is subject to quality assurance thereby ensuring safety, and 4) treatment can be offered at several centres allowing for equal access. Limitations include: 1) data collection from designated centres must be meticulous and submitted in a timely manner in order to accurately assess new technology, 2) CtE data can only be compared to published literature and historical controls as there is no comparator group. They point out that, in general, the level of evidence is not that of a randomised controlled trial, but this is an efficient method of improving access to new technology while building evidence for or against it.