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Cost-Effectiveness Analysis of Total Neoadjuvant Therapy Followed by Radical Resection Versus Conventional Therapy
Moriah E Wright1, Jennifer S Beaty1, Alan G Thorson1
1Section of Colorectal Surgery, Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska.
Diseases of the Colon and Rectum
|April 10, 2019
Summary
Total neoadjuvant therapy (TNT) is more cost-effective for locally advanced rectal cancer than standard care. TNT demonstrates better survival outcomes, especially when adjuvant chemotherapy compliance is low.
Area of Science:
- Oncology
- Health Economics
- Surgical Oncology
Background:
- Definitive surgery with total mesorectal excision is standard for locally advanced rectal cancer.
- Current standard involves neoadjuvant chemoradiation, surgery, and adjuvant chemotherapy.
- Low compliance (32%) with adjuvant chemotherapy necessitates evaluating alternative strategies.
Purpose of the Study:
- To compare the cost-effectiveness of total neoadjuvant therapy (TNT) versus the current standard of care for locally advanced rectal cancer.
- To identify the favored treatment strategy based on economic and survival outcomes.
Main Methods:
- Decision analytical modeling was employed to assess long-term costs and 5-year disease-free survival.
- Outcomes were modeled using Centers for Medicare & Medicaid Services billing data, national databases, and literature consensus.
- Sensitivity analysis was conducted to evaluate the impact of parameter uncertainty.
Main Results:
- Total neoadjuvant therapy (TNT) showed a cost-effectiveness of $40,708 per life-year, compared to $44,248 per life-year for the conventional approach.
- Sensitivity analysis indicated TNT as the dominant strategy with a 90% completion rate, even with adjuvant chemotherapy completion rates below 93%.
Conclusions:
- Total neoadjuvant therapy (TNT) followed by surgery is the favored strategy for locally advanced rectal cancer due to superior cost-effectiveness.
- Low adjuvant chemotherapy administration rates significantly reduce the cost-effectiveness of the standard care approach.
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