A cost and benefit study of esophagectomy for patients with esophageal cancer.
BACKGROUND
The incidence of esophageal cancer is increasing all over the world but the cost-and-benefit of esophagectomy for esophageal cancer patients was rarely studied. The aim of this study is to compare the cost-and-benefit of esophagectomy in different stages of esophageal cancer.


METHODS
Clinical and utilization data, including medical expenses and reason for treatment, of esophageal cancer patients were collected, summed and followed up for 5 years. The patients were divided into two groups according to their treatments, with or without esophagectomy. The monthly medical expense and relative expense performance index (REPI) were then calculated. Factors influenced total and monthly medical expense and survival time were further analyzed.


RESULTS
A total of 310 esophageal cancer patients, 281 male and mean age of 64.3, were included in this study. One hundred forty-nine patients had undergone esophagectomy. The 5-year survival rate, total and monthly medical expense for two groups was 36.0% and 10.2% (p<0.001), USD $22,532.8 vs. 12,256.4 (p<0.001) and USD $2,101.65 vs. 2,033.94 (p=0.831), respectively. The REPIs in four different stages were 7.573, 2.422, 2.446 and 0.705. Both esophagectomy and tumor stage were the sole factors that could influence total and monthly medical expense respectively. Both esophagectomy and tumor stage could influence a patient's survival time.


CONCLUSIONS
Esophagectomy has better performance than non-esophagectomy for patients with stages I to III esophageal cancer. Therefore, adding economical considerations, esophagectomy is recommended for patients, at least earlier than stage III.
Hsieh
Chih-Cheng
CC
Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Chien
Ching-Wen
CW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging