- 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.
- 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.
- 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.
- Nonexperimental design.