Cost-Effectiveness Analysis: Selective Use of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

Area of Science:

• Oncology
• Health Economics
• Clinical Decision Making

Background:

• Locally advanced rectal cancer (LARC) is highly curable with trimodal therapy.
• Studies suggest comparable outcomes when neoadjuvant chemoradiation (NAC) is selectively omitted in certain LARC patients.
• The cost-effectiveness of this selective approach requires thorough evaluation.

Purpose of the Study:

• To determine the cost-effectiveness of selectively using NAC in patients with LARC.
• To compare the economic and clinical value of selective versus universal NAC administration.

Main Methods:

• A cost-effectiveness analysis model was developed, comparing selective and blanket NAC strategies for LARC.
• The model incorporated data from literature reviews, expert consensus, and a prospective database.
• Health care utilization costs were sourced from Centers for Medicare and Medicaid Services data for adult patients with Stage II and III rectal cancer.

Main Results:

• The base-case analysis showed selective NAC as the dominant strategy, with lower costs ($153,176 vs. $176,362) and higher quality-adjusted life years (2.71 vs. 2.64 QALYs).
• Selective use resulted in a higher net monetary benefit (-$17,564 vs. -$44,217) compared to blanket use.
• Sensitivity analyses indicated selective NAC is preferred when 5-year disease-free survival exceeds 53.7%, and it was found to be optimal in 88% of probabilistic iterations.

Conclusions:

• Selective use of NAC is a superior strategy for LARC patients, particularly when the baseline 5-year disease-free survival is 65%.
• This cost-effective approach remains advantageous as long as disease-free survival in the selected group is above 53%.
• The findings support a more personalized treatment paradigm for LARC, optimizing resource allocation and patient outcomes.