A Cost-Effectiveness Analysis of Contact X-ray Brachytherapy for the Treatment of Patients with Rectal Cancer Following a Partial Response to Chemoradiotherapy. Issue 3 (March 2018)

• Record Type: Journal Article
• Authors: Rao, C.; Smith, F.M.; Martin, A.P.; Dhadda, A.S.; Stewart, A.; Gollins, S.; Collins, B.; Athanasiou, T.; Sun Myint, A.
• Is Part Of: Clinical oncology. Volume 30:Issue 3(2018)
• Page Start: 166
• Page End: 177
• Publication Date: 2018-03
• Subjects: Complete clinical response -- contact brachytherapy -- cost-effectiveness -- organ preservation -- rectal cancer -- watch and wait; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2017.11.015
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: 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. Materials and methods: 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) (WWCXB ), watch and wait with EBRT alone (WWEBRT ) and radical surgery for all patients. The effect of uncertainty in model parameters and patient demographics was investigated. Results: WWCXB had a higher QALY payoff than both radical surgery and WWEBRT and was less costly in most scenarios and demographic cohorts. In all plausible scenarios, WWCXB was the most cost-effective, at a threshold of £20 000/QALY. This finding was insensitive to uncertainty associated with model parameters. Conclusions: WWCXB is likely to be cost-effective compared with both WWEBRT alone and radical surgery. These findings support the use of CXB boost as an adjunct to a watch and wait strategy. Highlights: Watch and wait (WW) are more effective (QALY payoff) than surgical strategies. Contact brachytherapy boost when response to chemoradiotherapy was incomplete (WWCXB ) further improved efficacy. The effectiveness of WWCXB is independent of patient age and comorbidities. WWCXB is also less costly in most scenarios and demographic cohorts. WWCXB is cost-effective at a threshold of £20 000/QALY. When costs of stoma appliances are considered WWCXB is more cost-effective. The results are insensitive to uncertainty associated with model parameters.