Health economic evaluation of stent or endoluminal brachytherapy as a palliative strategy in patients with incurable cancer of the oesophagus or gastro-oesophageal junction: results of a randomized clinical trial.
OBJECTIVE
To relieve dysphagia is the main goal in palliative treatment of patients with incurable cancer of the oesophagus or the gastro-oesophageal junction. The aim of this prospective, randomized multicentre study was to compare stent placement and brachytherapy regarding health economy and clinical outcomes.


METHODS
Patients with incurable cancer of the oesophagus or gastro-oesophageal junction were randomized to receive a self-expandable metallic stent or 3 x 7 Gy brachytherapy. At clinical follow-up visits, dysphagia was scored and health care consumptions were recorded. Costs were based on hospital debits. Total lifetime healthcare consumption costs and costs for the initial treatments were calculated and a sensitivity analysis was conducted.


RESULTS
Thirty patients were randomized to each treatment group. There was no difference in survival or complication rates between the two treatment strategies. There was a significant difference in the change of dysphagia scores between the time of inclusion and the 1-month follow-up visit, in favour of the stented group (P = 0.03). This difference had disappeared at 3 months. Median total lifetime costs were 17,690 for the stented group compared with 33 171 for the brachytherapy group (P = 0.005). This difference was due to higher costs for the initial treatment (4615 versus 23 857, P < 0.0001). Sensitivity analyses showed that the charges for a brachytherapy session had to be reduced from 6092 to 4222 (31%) to make this therapeutic concept cost-competitive.


CONCLUSIONS
Stenting is currently more cost-effective compared with fractionated 3 x 7 Gy brachytherapy for patients with incurable cancer of the oesophagus and gastro-oesophageal junction.
Wenger
Urs
U
Department of Surgery, Karolinska University Hospital, Stockholm, Sweden. urs.wenger@karolinska.se
Johnsson
Erik
E
Bergquist
Henrik
H
Nyman
Jan
J
Ejnell
Hans
H
Lagergren
Jesper
J
Ruth
Magnus
M
Lundell
Lars
L
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003680:Deglutition Disorders / Q000191:economics / Q000532:radiotherapy / Q000628:therapy; D004938:Esophageal Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D004943:Esophagogastric Junction; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000191:economics*; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome