Rectal cancer: short-course RT most cost-effective for locally advanced disease

  • Raldow AC & al.
  • JAMA Netw Open
  • 5 Apr 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Short-course radiotherapy (SCRT) was a cost-effective alternative to long-course chemoradiotherapy (LCRT) in patients with locally advanced rectal cancer, except for distal tumors.

Why this matters

  • The results suggest that patients should receive preoperative SCRT unless they require tumor downstaging before resection.

Study design

  • Cost-effectiveness Markov model that simulated 10-year outcomes for 1 million 65-year-old patients with locally advanced rectal cancer treated with either SCRT or LCRT, who then would undergo surgery and chemotherapy.
  • Funding: STOP CANCER 2018 Richard Merkin, MD, Seed Grant.

Key results

  • The base case analysis showed SCRT was the cost-effective strategy (increment cost-effective ratio [ICER] of LCRT vs SCRT, $133,495/quality-adjusted life-year [QALY], which was greater than the willingness-to-pay threshold of $100,000/QALY).
  • A reanalysis that assumed all patients had distal tumors who would require abdominoperineal resection (APR), which assumed that 39% of LCRT patients initially assigned to APR would ultimately undergo sphincter-preserving surgery compared with 19% of those with SCRT, showed LCRT was more cost-effective in this group (ICER, $61,123/QALY) if at least 13.9% more patients in the LCRT group had tumor downstaging sufficient for low anterior resection.

Limitations

  • Nonexperimental design.

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