Cost Effectiveness of Watch and Wait Versus Resection in Rectal Cancer Patients with Complete Clinical Response to Neoadjuvant Chemoradiation
Autor: | Cui, Christina Liu, Luo, William Yu, Cosman, Bard Clifford, Eisenstein, Samuel, Simpson, Daniel, Ramamoorthy, Sonia, Murphy, James, Lopez, Nicole |
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Rok vydání: | 2022 |
Předmět: |
Comparative Effectiveness Research
Rectal Neoplasms Cost-Benefit Analysis Clinical Trials and Supportive Activities Oncology and Carcinogenesis Health Services Neoadjuvant Therapy Cost Effectiveness Research Clinical Research Quality of Life Humans Quality-Adjusted Life Years Patient Safety Oncology & Carcinogenesis health care economics and organizations Cancer 8.2 Health and welfare economics Health and social care services research |
Zdroj: | Annals of surgical oncology, vol 29, iss 3 |
Popis: | BackgroundWatch and wait (WW) protocols have gained increasing popularity for patients diagnosed with locally advanced rectal cancer and presumed complete clinical response after neoadjuvant chemoradiation. While studies have demonstrated comparable survival and recurrence rates between WW and radical surgery, the decision to undergo surgery has significant effects on patient quality of life. We sought to conduct a cost-effectiveness analysis comparing WW with abdominoperineal resection (APR) and low anterior resection (LAR) among patients with stage II/III rectal cancer.MethodsIn this comparative-effectiveness study, we built Markov microsimulation models to simulate disease progression, death, costs, and quality-adjusted life-years (QALYs) for WW or APR/LAR. We assessed cost effectiveness using the incremental cost-effectiveness ratio (ICER), with ICERs under $100,000/QALY considered cost effective. Probabilities of disease progression, death, and health utilities were extracted from published, peer-reviewed literature. We assessed costs from the payer perspective.ResultsWW dominated both LAR and APR at a willingness to pay (WTP) threshold of $100,000. Our model was most sensitive to rates of distant recurrence and regrowth after WW. Probabilistic sensitivity analysis demonstrated that WW was the dominant strategy over both APR and LAR over 100% of iterations across a range of WTP thresholds from $0-250,000.ConclusionsOur study suggests WW could reduce overall costs and increase effectiveness compared with either LAR or APR. Additional clinical research is needed to confirm the clinical efficacy and cost effectiveness of WW compared with surgery in rectal cancer. |
Databáze: | OpenAIRE |
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