C Rao1, F M Smith2, A P Martin3, A S Dhadda4, A Stewart5, S Gollins6, B Collins7, T Athanasiou8, A Sun Myint9. 1. Queen Elizabeth Hospital, Woolwich, London, UK. Electronic address: christopher.rao@nhs.net. 2. The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. 3. National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), University of Liverpool, Liverpool, UK. 4. Queen's Centre for Oncology & Haematology, Castle Hill Hospital, Hull, UK. 5. St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK. 6. North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, Denbighshire, UK. 7. Department of Public Health and Policy, University of Liverpool, Liverpool, UK. 8. Department of Surgery and Cancer, Imperial College London, London, UK. 9. The Clatterbridge Cancer Centre, Bebington, UK.
Abstract
AIMS: Following chemoradiotherapy in patients with rectal cancer, the addition of contact X-ray brachytherapy (CXB) in partial responders might increase the proportion of patients with a clinical complete response (cCR) and who are thus suitable for watch and wait management. However, the long-term cost-effectiveness of this approach has not been evaluated. MATERIALS AND METHODS: Decision analytical modelling and a Markov simulation were used to compare long-term costs, quality-adjusted life years (QALYs) and cost-effectiveness from a third-party payer (National Health Service) perspective for treatment strategies after chemoradiotherapy; watch and wait with CXB when a cCR was not initially achieved after external beam radiotherapy (EBRT) (WWCXB), watch and wait with EBRT alone (WWEBRT) and radical surgery for all patients. The effect of uncertainty in model parameters and patient demographics was investigated. RESULTS: WWCXB had a higher QALY payoff than both radical surgery and WWEBRT and was less costly in most scenarios and demographic cohorts. In all plausible scenarios, WWCXB was the most cost-effective, at a threshold of £20 000/QALY. This finding was insensitive to uncertainty associated with model parameters. CONCLUSIONS: WWCXB is likely to be cost-effective compared with both WWEBRT alone and radical surgery. These findings support the use of CXB boost as an adjunct to a watch and wait strategy.
AIMS: Following chemoradiotherapy in patients with rectal cancer, the addition of contact X-ray brachytherapy (CXB) in partial responders might increase the proportion of patients with a clinical complete response (cCR) and who are thus suitable for watch and wait management. However, the long-term cost-effectiveness of this approach has not been evaluated. MATERIALS AND METHODS: Decision analytical modelling and a Markov simulation were used to compare long-term costs, quality-adjusted life years (QALYs) and cost-effectiveness from a third-party payer (National Health Service) perspective for treatment strategies after chemoradiotherapy; watch and wait with CXB when a cCR was not initially achieved after external beam radiotherapy (EBRT) (WWCXB), watch and wait with EBRT alone (WWEBRT) and radical surgery for all patients. The effect of uncertainty in model parameters and patient demographics was investigated. RESULTS:WWCXB had a higher QALY payoff than both radical surgery and WWEBRT and was less costly in most scenarios and demographic cohorts. In all plausible scenarios, WWCXB was the most cost-effective, at a threshold of £20 000/QALY. This finding was insensitive to uncertainty associated with model parameters. CONCLUSIONS:WWCXB is likely to be cost-effective compared with both WWEBRT alone and radical surgery. These findings support the use of CXB boost as an adjunct to a watch and wait strategy.
Authors: Alexandra J Stewart; Evert J Van Limbergen; Jean-Pierre Gerard; Ane L Appelt; Frank Verhaegen; Maaike Berbee; Te Vuong; Ciarna Brooker; Tim Rockall; Arthur Sun Myint Journal: Clin Transl Radiat Oncol Date: 2021-12-11