Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer.
JAMA Netw Open
; 5(2): e2146312, 2022 02 01.
Article
in En
| MEDLINE
| ID: mdl-35103791
ABSTRACT
Importance Short-course radiotherapy and total neoadjuvant therapy (SCRT-TNT) followed by total mesorectal excision (TME) has emerged as a new treatment paradigm for patients with locally advanced rectal adenocarcinoma. However, the economic implication of this treatment strategy has not been compared with that of conventional long-course chemoradiotherapy (LCCRT) followed by TME with adjuvant chemotherapy. Objective:
To perform a cost-effectiveness analysis of SCRT-TNT vs LCCRT in conjunction with TME for patients with locally advanced rectal cancer. Design, Setting, andParticipants:
A decision analytical model with a 5-year time horizon was constructed for patients with biopsy-proven, newly diagnosed, primary locally advanced rectal adenocarcinoma treated with SCRT-TNT or LCCRT. Markov modeling was used to model disease progression and patient survival after treatment in 3-month cycles. Data on probabilities and utilities were extracted from the literature. Costs were evaluated from the Medicare payer's perspective in 2020 US dollars. Sensitivity analyses were performed for key variables. Data were collected from October 3, 2020, to January 20, 2021, and analyzed from November 15, 2020, to April 25, 2021. Exposures Two treatment strategies, SCRT-TNT vs LCCRT with adjuvant chemotherapy, were compared. Main Outcomes andMeasures:
Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Both costs and QALYs were discounted at 3% annually. Willingness-to-pay threshold was set at $50â¯000/QALY.Results:
During the 5-year horizon, the total cost was $41â¯355 and QALYs were 2.21 for SCRT-TNT; for LCCRT, the total cost was $54â¯827 and QALYs were 2.12, resulting in a negative incremental cost-effectiveness ratio (-$141â¯256.77). The net monetary benefit was $69â¯300 for SCRT-TNT and $51â¯060 for LCCRT. Sensitivity analyses using willingness to pay at $100â¯000/QALY and $150â¯000/QALY demonstrated the same conclusion. Conclusions and Relevance These findings suggest that SCRT-TNT followed by TME incurs lower cost and improved QALYs compared with conventional LCCRT followed by TME and adjuvant chemotherapy. These data offer further rationale to support SCRT-TNT as a novel cost-saving treatment paradigm in the management of locally advanced rectal cancer.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Rectal Neoplasms
/
Adenocarcinoma
/
Antineoplastic Combined Chemotherapy Protocols
/
Cost-Benefit Analysis
/
Neoadjuvant Therapy
/
Chemoradiotherapy
Type of study:
Health_economic_evaluation
/
Prognostic_studies
Aspects:
Patient_preference
Country/Region as subject:
America do norte
Language:
En
Journal:
JAMA Netw Open
Year:
2022
Document type:
Article