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Economic Analysis of Adjuvant Chemoradiotherapy Compared with Chemotherapy in Resected Pancreas Cancer.
Vela, Nivethan; Davis, Laura E; Cheng, Stephanie Y; Hammad, Ahmed; Liu, Ying; Kagedan, Daniel J; Paszat, Lawrence; Bubis, Lev D; Earle, Craig C; Myrehaug, Sten; Mahar, Alyson L; Mittmann, Nicole; Coburn, Natalie G.
Afiliação
  • Vela N; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
  • Davis LE; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • Cheng SY; Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada.
  • Hammad A; Department of General Surgery, Mansoura University Hospitals, Mansoura, Egypt.
  • Liu Y; Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada.
  • Kagedan DJ; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Paszat L; Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada.
  • Bubis LD; Division of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
  • Earle CC; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Myrehaug S; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • Mahar AL; Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada.
  • Mittmann N; Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, Canada.
  • Coburn NG; Division of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Ann Surg Oncol ; 26(13): 4193-4203, 2019 Dec.
Article em En | MEDLINE | ID: mdl-31535303
ABSTRACT

BACKGROUND:

Population-based survival and costs of pancreas adenocarcinoma patients receiving adjuvant chemoradiation and chemotherapy following pancreaticoduodenectomy are poorly understood.

METHODS:

This retrospective cohort study used linked administrative and pathological datasets to identify all patients diagnosed with pancreas adenocarcinoma and undergoing pancreaticoduodenectomy in Ontario between April 2004 and March 2014, who received postoperative chemoradiation or chemotherapy. Stage and margin status were defined by using pathology reports. Kaplan-Meier and Cox proportional hazards regression survival analyses were used to determine associations between adjuvant treatment approach and survival, while stratifying by margin status. Median overall health system costs were calculated at 1 and 3 years for chemoradiation and chemotherapy, and differences were tested using the Kruskal-Wallis test.

RESULTS:

Among 709 patients undergoing pancreaticoduodenectomy for pancreas cancer during the study period, the median survival was 21 months. Median survival was 19 months for chemoradiation and 22 months for chemotherapy. Patients receiving chemoradiation were more likely to have positive margins 47.7% compared with 19.2% in chemotherapy. After stratifying by margin status and controlling for confounders, adjusted hazard ratio of death were not statistically different between chemotherapy and chemoradiation [margin positive, hazard ratio (HR) = 0.99, 95% confidence interval (CI) = 0.88-1.27; margin negative, HR 0.95, 95% CI 0.91-1.18]. Overall 1-year health system costs were significantly higher for chemoradiation (USD $70,047) than chemotherapy (USD $54,005) (p ≤ 0.001).

CONCLUSIONS:

Chemotherapy and chemoradiation yielded similar survival, but chemoradiation resulted in higher costs. To create more sustainable healthcare systems, both the efficacy and costs of therapies should be considered.
Assuntos

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Adenocarcinoma / Protocolos de Quimioterapia Combinada Antineoplásica / Quimioterapia Adjuvante / Quimiorradioterapia Adjuvante Tipo de estudo: Health_economic_evaluation / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Oncol Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Adenocarcinoma / Protocolos de Quimioterapia Combinada Antineoplásica / Quimioterapia Adjuvante / Quimiorradioterapia Adjuvante Tipo de estudo: Health_economic_evaluation / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Oncol Ano de publicação: 2019 Tipo de documento: Article