A Cost-Effectiveness Analysis of Contact X-ray Brachytherapy for the Treatment of Patients with Rectal Cancer Following a Partial Response to Chemoradiotherapy

Rao, C, Smith, FM, Martin, AP ORCID: 0000-0003-4383-6038, Dhadda, AS, Stewart, A, Gollins, S, Collins, B ORCID: 0000-0002-3023-8189, Athanasiou, T and Myint, A Sun (2018) A Cost-Effectiveness Analysis of Contact X-ray Brachytherapy for the Treatment of Patients with Rectal Cancer Following a Partial Response to Chemoradiotherapy. CLINICAL ONCOLOGY, 30 (3). pp. 166-177.

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Official URL: http://dx.doi.org/10.1016/j.clon.2017.11.015

Abstract

<h4>Aims</h4>Following chemoradiotherapy in patients with rectal cancer, the addition of contact X-ray brachytherapy (CXB) in partial responders might increase the proportion of patients with a clinical complete response (cCR) and who are thus suitable for watch and wait management. However, the long-term cost-effectiveness of this approach has not been evaluated.<h4>Materials and methods</h4>Decision analytical modelling and a Markov simulation were used to compare long-term costs, quality-adjusted life years (QALYs) and cost-effectiveness from a third-party payer (National Health Service) perspective for treatment strategies after chemoradiotherapy; watch and wait with CXB when a cCR was not initially achieved after external beam radiotherapy (EBRT) (WW<sub>CXB</sub>), watch and wait with EBRT alone (WW<sub>EBRT</sub>) and radical surgery for all patients. The effect of uncertainty in model parameters and patient demographics was investigated.<h4>Results</h4>WW<sub>CXB</sub> had a higher QALY payoff than both radical surgery and WW<sub>EBRT</sub> and was less costly in most scenarios and demographic cohorts. In all plausible scenarios, WW<sub>CXB</sub> was the most cost-effective, at a threshold of £20 000/QALY. This finding was insensitive to uncertainty associated with model parameters.<h4>Conclusions</h4>WW<sub>CXB</sub> is likely to be cost-effective compared with both WW<sub>EBRT</sub> alone and radical surgery. These findings support the use of CXB boost as an adjunct to a watch and wait strategy.

Item Type:	Article
Uncontrolled Keywords:	Complete clinical response, contact brachytherapy, cost-effectiveness, organ preservation, rectal cancer, watch and wait
Depositing User:	Symplectic Admin
Date Deposited:	12 Feb 2018 08:51
Last Modified:	19 Jan 2023 06:39
DOI:	10.1016/j.clon.2017.11.015
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3017976