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Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer
Georg W Wurschi1,2,3, Alexander Rühle4,5,6, Justus Domschikowski7
1Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07747 Jena, Germany.
Total neoadjuvant therapy (TNT) is more cost-effective and improves quality of life for rectal cancer patients compared to traditional chemoradiation (CRT) and surgery. This approach reduces patient expenses and avoids the need for ostomy care, enhancing overall well-being.
Area of Science:
- Oncology
- Health Economics
- Health Services Research
Background:
- Total neoadjuvant therapy (TNT) is an emerging treatment for locally advanced rectal cancer (LARC).
- Complete response to TNT may allow for organ preservation and avoidance of permanent ostomy, potentially improving patient quality of life (QoL).
- The economic implications for patients undergoing TNT versus standard neoadjuvant chemoradiation (CRT) followed by resection are not well-established.
Purpose of the Study:
- To conduct the first patient-perspective cost-effectiveness analysis comparing TNT with radical resection after neoadjuvant CRT in the German healthcare system.
- To evaluate the financial impact and QoL outcomes for patients receiving TNT versus CRT followed by resection.
Main Methods:
- A Markov microsimulation model was employed to calculate individual patient costs for those with statutory health insurance.
- Model parameters were calibrated using subgroup data from the prospective
- FinTox
- trial.
- The analysis considered costs related to treatment, ostomy care, medication, and loss of earnings over a 5-year follow-up period.
Main Results:
- TNT was found to be less expensive (-1540 EUR) and yielded better QoL outcomes (+0.64 QALYs) compared to CRT followed by resection.
- The average annual cost for patients on TNT was 4711 EUR, representing 3.2% of net household income.
- CRT followed by resection incurred higher costs due to ostomy care, medication, and greater loss of earnings.
Conclusions:
- Total neoadjuvant therapy (TNT) is more efficacious and cost-effective from a patient's perspective within the German healthcare system.
- TNT offers significant advantages in terms of reduced patient costs and improved quality of life, particularly by potentially avoiding definitive ostomy.
- The findings support TNT as a preferred treatment strategy for eligible patients with locally advanced rectal cancer.
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