Cost-Effectiveness of Radiation Techniques for Locally Advanced Rectal Adenocarcinoma
A comparative effectiveness study examined the costs associated with short-course radiation therapy versus long-course chemoradiation for locally advanced rectal adenocarcinoma.
The study was presented at the 2018 Gastrointestinal Cancers Symposium (January 18-20, 2018; San Francisco, CA).
Currently, the standard of care in the United States for locally advanced rectal cancer is long-course chemoradiation (50.4 Gy in 28 fractions with concurrent chemotherapy) followed by surgery and adjuvant chemotherapy. However, many other countries use short-course radiation therapy (25 Gy in 5 fractions) for this disease.
Ann C Raldow, MD, MPH, radiation oncologist, UCLA David Geffen School of Medicine, and colleagues conducted a study to analyze the cost-effectiveness of these two radiation techniques. Researchers developed a cost-effectiveness model that simulated 10-year outcomes for patients aged 65 years who were treated with either short-course radiation therapy or long-course chemoradiation.
Probabilities, utilities, and costs based on the literature and Medicare Fee schedules were used to determine the incremental cost-effectiveness ratio (ICER) of both treatments. The pre-defined threshold for cost-effectiveness was $100,000 per quality-adjusted life-year (QALY) or less.
Results of the study showed that short-course radiation therapy had an ICER of $351,731 per QALY, which made it more cost-effective than long-course chemoradiation. Short-course radiation therapy remained the more cost-effective strategy with 3D-conformal treatment for long-course chemoradiation, but intensity modulated radiation therapy for short-course radiation therapy (ICER, $314,022 per QALY).
Furthermore, one-way sensitivity analysis showed that long-course chemoradiation became the more cost-effective approach when the utility of no evidence of disease with abdominoperineal resection state was below 0.61. Two-way sensitivity analysis showed that the more cost-effective strategy for a given patient depended on the utilities for the no evidence of disease with low anterior resection and abdominoperineal resection states.
Dr Raldow and colleagues concluded that while short-course radiation therapy is a more cost-effective strategy than long-course chemoradiation for locally advanced rectal adenocarcinoma, the importance of patient preference-sensitive care cannot be understated.—Zachary Bessette