Watch-and-Wait policy versus robotic surgery for locally advanced rectal cancer: A cost-effectiveness study (RECCOSTE). (May 2022)

• Record Type: Journal Article
• Authors: Rodriguez-Pascual, Jesus; Nuñez-Alfonsel, Javier; Ielpo, Benedetto; Lopez, Mercedes; Quijano, Yolanda; de Vicente, Emilio; Cubillo, Antonio; Saborido, Carlos Martin
• Is Part Of: Surgical oncology. Volume 41(2022)
• Publication Date: 2022-05
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2022.101710
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Introduction: Complete surgical resection for locally advanced rectal cancer is the standard treatment after a clinical complete response following chemoradiotherapy. However, some novel clinical approaches could achieve better functional results, such as Robotic Resection, or avoiding surgical procedure and incrementing surveillance intensity, called Watch-and-Wait policy. We use computational techniques to compare these clinical approaches using quality adjusted life years (QALYs). Methods: A Markov decision analytic model was used in order to perform a cost-utility analysis, comparing standard resection (SR), Robotic Rectal Resection (RRR) and Watch-and-Wait (WW) strategies, estimating the incremental cost-effectiveness ratio per QALY to be gained from patients reaching a clinical complete response to chemoradiotherapy. Model parameter estimates were informed by previously published studies comparing WW to SR and from our database of RRR versus SR. Lifetime incremental cost-utility ratio was calculated among approaches, and a sensitivity analysis were performed in order to estimate the model uncertainty. A willingness-to-pay of per one additional QALY gained was measured to determine which strategies would be most cost-effective. Results: WW is a dominating option over SR ( -75, 486. 75 € and +2.04 QALYs) and RRR ( -75, 486. 75 € and +0.41 QALYs). The cost-effectiveness plane shows that WW does not always dominate over RRR or SR. WW saves costs in 99.98% of the simulations when compared with either SR or RRR but only 86.9% and 55.38% (respectively) of these fall within the SR quadrant. WW is only more effective than SR 55% of the time which implies a significant uncertainty due to the high utility value assigned to cCR after chemoradiotherapy in the RRR alternative. Conclusion: This study provides data of cost-effectiveness differences among Standard Surgery, Watch-and-Wait and Robotic Resection approaches in clinical complete response in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy, showing a benefit for Watch-and-Wait policy. Highlights: Complete response after radiotherapy in rectal cancer implies favorable prognosis. Standard or robotic resection versus watch-and-wait policy are possible strategies. We compared these clinical approaches using quality adjusted life years. A Markov decision analytic model was created to evaluate these possible treatments.