title: Clinical and Economic Evaluation of Treatment Strategies for T1N0 Anal Canal Cancer.
abstract: A comparative assessment of treatment alternatives for T1N0 anal canal cancer has never been conducted. We compared the outcomes associated with the treatment alternatives-chemoradiotherapy (CRT), radiotherapy (RT), and surgery or ablation techniques (surgery/ablation)-for T1N0 anal canal cancer.
  
  
  
  This retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER) registries linked with Medicare longitudinal data (SEER-Medicare database). Analysis included 190 patients who were treated for T1N0 anal canal cancer using surgery/ablation (n=44), RT (n=50), or CRT (n=96). The outcomes were reported in terms of survival and hazards ratios using Kaplan-Meier and Cox proportional hazards modeling, respectively; lifetime costs; and cost-effectiveness measured in terms of incremental cost-effectiveness ratio, that is, the ratio of the difference in costs between the 2 alternatives to the difference in effectiveness between the same 2 alternatives.
  
  
  
  There was no significant difference in the survival duration between the treatment groups as predicted by the Kaplan-Meier curves. After adjusting for patient characteristics and propensity score, the hazard ratio of death for the patients who received CRT compared with surgery/ablation was 1.742 (95% confidence interval, 0.793-3.829) and RT was 2.170 (95% confidence interval, 0.923-5.101); however, the relationship did not reach statistical significance. Surgery/ablation resulted in lower lifetime cost than RT or CRT. The incremental cost-effectiveness ratio associated with CRT compared with surgery/ablation was $142,883 per life year gained.
  
  
  
  There was no statistically significant difference in survival among the treatment alternatives for T1N0 anal canal cancer. Given that surgery/ablation costs less than RT or CRT and might be cost-effective compared with RT and CRT, it is crucial to explore this finding further in this era of limited health care resources.
authors.affiliation: Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL.
authors.forename: Ashish A
authors.initials: AA
authors.lastname: Deshmukh
authors.affiliation: Departments of Health Services Research.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Radiation Oncology.
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.affiliation: Department of Medicine, Section of Infectious Disease, Baylor College of Medicine.
authors.forename: Elizabeth Y
authors.initials: EY
authors.lastname: Chiao
authors.affiliation: Surgical Oncology, The University of Texas MD Anderson Cancer Center.
authors.forename: Yi-Qian Nancy
authors.initials: YN
authors.lastname: You
authors.affiliation: Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD.
authors.forename: Luisa
authors.initials: L
authors.lastname: Franzini
authors.affiliation: The University of Texas Health Science Center of Houston School of Public Health, Houston, TX.
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.affiliation: The University of Texas Health Science Center of Houston School of Public Health, Houston, TX.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Swartz
authors.affiliation: Departments of Health Services Research.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Departments of Health Services Research.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate