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Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer

IMPORTANCE: Short-course radiotherapy and total neoadjuvant therapy (SCRT-TNT) followed by total mesorectal excision (TME) has emerged as a new treatment paradigm for patients with locally advanced rectal adenocarcinoma. However, the economic implication of this treatment strategy has not been compa...

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Autores principales: Chin, Re-I, Otegbeye, Ebunoluwa E., Kang, Kylie H., Chang, Su-Hsin, McHenry, Scott, Roy, Amit, Chapman, William C., Henke, Lauren E., Badiyan, Shahed N., Pedersen, Katrina, Tan, Benjamin R., Glasgow, Sean C., Mutch, Matthew G., Samson, Pamela P., Kim, Hyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808328/
https://www.ncbi.nlm.nih.gov/pubmed/35103791
http://dx.doi.org/10.1001/jamanetworkopen.2021.46312
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author Chin, Re-I
Otegbeye, Ebunoluwa E.
Kang, Kylie H.
Chang, Su-Hsin
McHenry, Scott
Roy, Amit
Chapman, William C.
Henke, Lauren E.
Badiyan, Shahed N.
Pedersen, Katrina
Tan, Benjamin R.
Glasgow, Sean C.
Mutch, Matthew G.
Samson, Pamela P.
Kim, Hyun
author_facet Chin, Re-I
Otegbeye, Ebunoluwa E.
Kang, Kylie H.
Chang, Su-Hsin
McHenry, Scott
Roy, Amit
Chapman, William C.
Henke, Lauren E.
Badiyan, Shahed N.
Pedersen, Katrina
Tan, Benjamin R.
Glasgow, Sean C.
Mutch, Matthew G.
Samson, Pamela P.
Kim, Hyun
author_sort Chin, Re-I
collection PubMed
description IMPORTANCE: Short-course radiotherapy and total neoadjuvant therapy (SCRT-TNT) followed by total mesorectal excision (TME) has emerged as a new treatment paradigm for patients with locally advanced rectal adenocarcinoma. However, the economic implication of this treatment strategy has not been compared with that of conventional long-course chemoradiotherapy (LCCRT) followed by TME with adjuvant chemotherapy. OBJECTIVE: To perform a cost-effectiveness analysis of SCRT-TNT vs LCCRT in conjunction with TME for patients with locally advanced rectal cancer. DESIGN, SETTING, AND PARTICIPANTS: A decision analytical model with a 5-year time horizon was constructed for patients with biopsy-proven, newly diagnosed, primary locally advanced rectal adenocarcinoma treated with SCRT-TNT or LCCRT. Markov modeling was used to model disease progression and patient survival after treatment in 3-month cycles. Data on probabilities and utilities were extracted from the literature. Costs were evaluated from the Medicare payer’s perspective in 2020 US dollars. Sensitivity analyses were performed for key variables. Data were collected from October 3, 2020, to January 20, 2021, and analyzed from November 15, 2020, to April 25, 2021. EXPOSURES: Two treatment strategies, SCRT-TNT vs LCCRT with adjuvant chemotherapy, were compared. MAIN OUTCOMES AND MEASURES: Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Both costs and QALYs were discounted at 3% annually. Willingness-to-pay threshold was set at $50 000/QALY. RESULTS: During the 5-year horizon, the total cost was $41 355 and QALYs were 2.21 for SCRT-TNT; for LCCRT, the total cost was $54 827 and QALYs were 2.12, resulting in a negative incremental cost-effectiveness ratio (−$141 256.77). The net monetary benefit was $69 300 for SCRT-TNT and $51 060 for LCCRT. Sensitivity analyses using willingness to pay at $100 000/QALY and $150 000/QALY demonstrated the same conclusion. CONCLUSIONS AND RELEVANCE: These findings suggest that SCRT-TNT followed by TME incurs lower cost and improved QALYs compared with conventional LCCRT followed by TME and adjuvant chemotherapy. These data offer further rationale to support SCRT-TNT as a novel cost-saving treatment paradigm in the management of locally advanced rectal cancer.
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spelling pubmed-88083282022-02-09 Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer Chin, Re-I Otegbeye, Ebunoluwa E. Kang, Kylie H. Chang, Su-Hsin McHenry, Scott Roy, Amit Chapman, William C. Henke, Lauren E. Badiyan, Shahed N. Pedersen, Katrina Tan, Benjamin R. Glasgow, Sean C. Mutch, Matthew G. Samson, Pamela P. Kim, Hyun JAMA Netw Open Original Investigation IMPORTANCE: Short-course radiotherapy and total neoadjuvant therapy (SCRT-TNT) followed by total mesorectal excision (TME) has emerged as a new treatment paradigm for patients with locally advanced rectal adenocarcinoma. However, the economic implication of this treatment strategy has not been compared with that of conventional long-course chemoradiotherapy (LCCRT) followed by TME with adjuvant chemotherapy. OBJECTIVE: To perform a cost-effectiveness analysis of SCRT-TNT vs LCCRT in conjunction with TME for patients with locally advanced rectal cancer. DESIGN, SETTING, AND PARTICIPANTS: A decision analytical model with a 5-year time horizon was constructed for patients with biopsy-proven, newly diagnosed, primary locally advanced rectal adenocarcinoma treated with SCRT-TNT or LCCRT. Markov modeling was used to model disease progression and patient survival after treatment in 3-month cycles. Data on probabilities and utilities were extracted from the literature. Costs were evaluated from the Medicare payer’s perspective in 2020 US dollars. Sensitivity analyses were performed for key variables. Data were collected from October 3, 2020, to January 20, 2021, and analyzed from November 15, 2020, to April 25, 2021. EXPOSURES: Two treatment strategies, SCRT-TNT vs LCCRT with adjuvant chemotherapy, were compared. MAIN OUTCOMES AND MEASURES: Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Both costs and QALYs were discounted at 3% annually. Willingness-to-pay threshold was set at $50 000/QALY. RESULTS: During the 5-year horizon, the total cost was $41 355 and QALYs were 2.21 for SCRT-TNT; for LCCRT, the total cost was $54 827 and QALYs were 2.12, resulting in a negative incremental cost-effectiveness ratio (−$141 256.77). The net monetary benefit was $69 300 for SCRT-TNT and $51 060 for LCCRT. Sensitivity analyses using willingness to pay at $100 000/QALY and $150 000/QALY demonstrated the same conclusion. CONCLUSIONS AND RELEVANCE: These findings suggest that SCRT-TNT followed by TME incurs lower cost and improved QALYs compared with conventional LCCRT followed by TME and adjuvant chemotherapy. These data offer further rationale to support SCRT-TNT as a novel cost-saving treatment paradigm in the management of locally advanced rectal cancer. American Medical Association 2022-02-01 /pmc/articles/PMC8808328/ /pubmed/35103791 http://dx.doi.org/10.1001/jamanetworkopen.2021.46312 Text en Copyright 2022 Chin RI et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Chin, Re-I
Otegbeye, Ebunoluwa E.
Kang, Kylie H.
Chang, Su-Hsin
McHenry, Scott
Roy, Amit
Chapman, William C.
Henke, Lauren E.
Badiyan, Shahed N.
Pedersen, Katrina
Tan, Benjamin R.
Glasgow, Sean C.
Mutch, Matthew G.
Samson, Pamela P.
Kim, Hyun
Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer
title Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer
title_full Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer
title_fullStr Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer
title_full_unstemmed Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer
title_short Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer
title_sort cost-effectiveness of total neoadjuvant therapy with short-course radiotherapy for resectable locally advanced rectal cancer
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808328/
https://www.ncbi.nlm.nih.gov/pubmed/35103791
http://dx.doi.org/10.1001/jamanetworkopen.2021.46312
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