Cost-effectiveness of preoperative radiotherapy in rectal cancer: results from the Swedish Rectal Cancer Trial.
OBJECTIVE
The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short-term regimen of high-dose fractionated preoperative radiotherapy (5 x 5 Gy) reduced the local recurrence rates and improved overall survival. This has had an impact on the primary treatment of rectal cancer. The current study investigated the cost-effectiveness of the new combined approach.


METHODS
After an 8-year follow-up, in-hospital and outpatient costs related to the treatment of rectal cancer and its complications were analyzed for 98 randomly allocated patients who participated in the SRCT from a single Swedish health care region. The costs were then related to the clinical data from the SRCT regarding complications, local and distant recurrences, and survival.


RESULTS
The total cost for a nonirradiated patient was US$30,080 compared with US$35,268 for an irradiated patient. The surgery-alone group had increased costs related to local recurrences, and the radiotherapy group had increased costs for irradiation and complications. With a survival benefit of 21 months (retrieved from the SRCT), the cost for a saved year was US$3654. Sensitivity analyses for different rates of local recurrences, the costs related to complications and less marked survival benefit showed that this figure could vary up to US$15,228.


CONCLUSIONS
The cost for a life-year saved in these data was US$3654. This figure could reach US$15,228 in the most pessimistic setting of the sensitivity tests, a cost still comparable with other well-accepted medical interventions.
Dahlberg
Michael
M
Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden. michael.dahlberg@nll.se
Stenborg
Anna
A
Påhlman
Lars
L
Glimelius
Bengt
B
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics*; D011878:Radiotherapy / Q000191:economics; D012004:Rectal Neoplasms / Q000191:economics* / Q000532:radiotherapy* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden; D026712:Value of Life / Q000191:economics