Cost-utility analysis of preoperative radiotherapy in patients with rectal cancer undergoing total mesorectal excision: a study of the Dutch Colorectal Cancer Group.
OBJECTIVE
To compare the societal costs and the (quality-adjusted) life expectancy of patients with rectal cancer undergoing total mesorectal excision (TME) with or without short-term preoperative radiotherapy (5 x 5 Gy).


METHODS
We used a Markov model to project the clinical and economic outcomes of preoperative radiotherapy. Data on local recurrence rates, quality of life, and costs were obtained from the patients of a multicenter randomized clinical trial. In this trial, 1,861 patients with resectable rectal cancer from 108 hospitals were randomly assigned for TME surgery with or without preoperative radiotherapy. Outcome measures of the model were life expectancy, quality-adjusted life expectancy, lifetime costs per patient, and the incremental cost-effectiveness ratio.


RESULTS
The base case model estimates that the loss of quality of life due to preoperative radiotherapy is outweighed by the gain in life expectancy. Life expectancy increases by 0.67 years; quality-adjusted life expectancy, by 0.39 years; and costs, by $9,800 per patient. The corresponding cost-effectiveness ratio is $25,100 per quality-adjusted life year. Sensitivity analyses indicate that the cost-effectiveness ratio remains acceptable under a wide range of assumptions.


CONCLUSIONS
Assuming that the reduced local recurrence rate does lead to a survival advantage, the cost-utility analysis estimates that the improved survival outweighs the impaired quality of life and the increased costs. We conclude that short-term preoperative radiotherapy in patients with rectal cancer undergoing TME is both effective and cost-effective.
Van Den Brink
Mandy
M
Department of Medical Decision Making, J10-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
Van Den Hout
Wilbert B
WB
Stiggelbout
Anne M
AM
Klein Kranenbarg
Elma
E
Marijnen
Corrie A M
CA
Van De Velde
Cornelis J H
CJ
Kievit
Job
J
D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000191:economics*; D009364:Neoplasm Recurrence, Local; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011878:Radiotherapy / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000191:economics / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis