The management of oesophageal carcinoma: radiotherapy or surgery? Cost considerations.

A cost comparison has been made between two treatment modalities used with curative intent for carcinoma of the oesophagus, for 144 patients seen between December 1979 and December 1985. Forty-two patients were selected for radical oesophagectomy. In this paper these are compared with 50 patients who underwent radical radiotherapy. The median survival of both groups was identical (12 months). The remaining 52 patients underwent a variety of palliative procedures and are not considered further. Components of management were identified and costed on the basis of direct resource use by the hospital. Surgically treated patients on average cost $A13,638 in 1987 dollars, whereas those treated by radiotherapy cost $A3533. The major factors accounting for this cost difference were the necessary perioperative intensive management in the surgical group, the inevitable perioperative complications and the subsequent prolonged hospitalization of a proportion of patients. The cost of the management of the complications of radiation therapy are included but were not a major factor in overall costs for the irradiated group. This cost differential must influence the continuation of current strategies in which radical surgery, rather than irradiation, is the selected routine curative approach for oesophageal cancer particularly in the absence of evidence of higher survival.