Avoiding Radical Surgery in Elderly Patients With Rectal Cancer Is Cost-Effective



Rao, Christopher, Myint, Arthur Sun, Athanasiou, Thanos, Faiz, Omar, Martin, Antony Paul ORCID: 0000-0003-4383-6038, Collins, Brendan ORCID: 0000-0002-3023-8189 and Smith, Fraser McLean
(2017) Avoiding Radical Surgery in Elderly Patients With Rectal Cancer Is Cost-Effective. , United States.

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Abstract

<h4>Background</h4>Radical surgery is associated with significant perioperative mortality in elderly and comorbid populations. Emerging data suggest for patients with a clinical complete response after neoadjuvant chemoradiotherapy that a watch-and-wait approach may provide equivalent survival and oncological outcomes.<h4>Objective</h4>The purpose of this study was to compare the cost-effectiveness of watch and wait and radical surgery for patients with rectal cancer after a clinical complete response following chemoradiotherapy.<h4>Design</h4>Decision analytical modeling and a Markov simulation were used to model long-term costs, quality-adjusted life-years, and cost-effectiveness after watch and wait and radical surgery. Sensitivity analysis was used to investigate the effect of uncertainty in model parameters.<h4>Settings</h4>A third-party payer perspective was adopted.<h4>Patients</h4>Patients included in the study were a 60-year-old male cohort with no comorbidities, 80-year-old male cohorts with no comorbidities, and 80-year-old male cohorts with significant comorbidities.<h4>Interventions</h4>Radical surgery and watch-and-wait approaches were studied.<h4>Main outcome measures</h4>Incremental cost, effectiveness, and cost-effectiveness ratio over the entire lifetime of the hypothetical patient cohorts were measured.<h4>Results</h4>Watch and wait was more effective (60-year-old male cohort with no comorbidities = 0.63 quality-adjusted life-years (95% CI, 2.48-3.65 quality-adjusted life-years); 80-year-old male cohort with no comorbidities = 0.56 quality-adjusted life-years (95% CI, 0.52-1.59 quality-adjusted life-years); 80-year-old male cohort with significant comorbidities = 0.72 quality-adjusted life-years (95% CI, 0.34-1.76 quality-adjusted life-years)) and less costly (60-year-old male cohort with no comorbidities = $11,332.35 (95% CI, $668.50-$23,970.20); 80-year-old male cohort with no comorbidities = $8783.93 (95% CI, $2504.26-$21,900.66); 80-year-old male cohort with significant comorbidities = $10,206.01 (95% CI, $2762.014-$24,135.31)) independent of patient cohort age and comorbidity. Consequently, watch and wait was more cost-effective with a high degree of certainty (range, 69.6%-89.2%) at a threshold of $50,000/quality-adjusted life-year.<h4>Limitations</h4>Long-term outcomes were derived from modeled cohorts. Analysis was performed for a United Kingdom third-party payer perspective, limiting generalizability to other healthcare contexts.<h4>Conclusions</h4>Watch and wait is likely to be cost-effective compared with radical surgery. These findings strongly support the discussion of organ-preserving strategies with suitable patients.

Item Type: Conference or Workshop Item (Unspecified)
Uncontrolled Keywords: Complete clinical response, Cost-effectiveness, Elderly, Neoadjuvant, Radiotherapy, Rectal, Watch and wait
Depositing User: Symplectic Admin
Date Deposited: 05 Apr 2017 07:20
Last Modified: 20 Jan 2023 03:00
DOI: 10.1097/DCR.0000000000000708
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3006784