Objective: The choice between neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) remains controversial in the treatment of non-small cell lung cancer (NSCLC). There is no significant difference in NAC and AC’s effectiveness. We investigate the cost-effectiveness of NAC versus AC for NSCLC. Method: A decision tree model was designed from a payer perspective to compare NAC and AC treatments for NSCLC. Parameters included overall survival (OS), surgical complications, chemotherapy adverse event (AE), treatment initiation probability, treatment time frame, treatment cost, and quality of life (QOL). Sensitivity analyses were performed to characterize model uncertainty in the base cases. Result: With the same overall survival, AC treatment strategy produces a cost saving of ￥618.90 and an incremental quality-adjusted life-years (QALY) of 0.10 years per patient. If median OS of NAC is 1.4 months more than AC, NAC would be cost effective (CE) at a ￥35446/QALY threshold. The model was robust enough to handle variations to all input parameters except the overall survival. In the probability sensitivity analysis, AC remained dominant in 54.6% of simulations. Conclusion: The modeled cost effectiveness analysis indicates that with operable NSCLC, AC treatment is more cost effective compared to NAC. If NAC provides a longer survival advantage, this treatment strategy may be cost-effective. The OS is the main factor that influences cost-effectiveness analysis.