Watch and wait for rectal cancer: assessing the cost effectiveness in Latin America

Abstract Background Watch and wait (WW) protocols have gained increasing popularity for patients diagnosed with locally advanced rectal cancer and presumed complete clinical response after neoadjuvant chemoradiation. While studies have demonstrated comparable survival and recurrence rates between WW and radical surgery, the decision to undergo surgery has significant effects on patient quality of life. We sought to conduct a cost-effectiveness analysis comparing WW with abdominoperineal resection (APR) and low anterior resection (LAR) among patients with stage II/III rectal cancer. Methods In this comparative-effectiveness study, we built Markov microsimulation models to simulate disease progression, death, costs, and quality-adjusted life-years (QALYs) for WW or APR/LAR. We assessed cost effectiveness using the incremental cost-effectiveness ratio (ICER), with ICERs under $100,000/QALY considered cost effective. Probabilities of disease progression, death, and health utilities were extracted from published, peer-reviewed literature. We assessed costs from the payer perspective. Results WW dominated both LAR and APR at a willingness to pay (WTP) threshold of $100,000. Our model was most sensitive to rates of distant recurrence and regrowth after WW. Probabilistic sensitivity analysis demonstrated that WW was the dominant strategy over both APR and LAR over 100% of iterations across a range of WTP thresholds from $0–250,000. Conclusions Our study suggests WW could reduce overall costs and increase effectiveness compared with either LAR or APR. Additional clinical research is needed to confirm the clinical efficacy and cost effectiveness of WW compared with surgery in rectal cancer.

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ASO Author Reflections: Bang for Your Buck—Implications of the Cost-Effectiveness of Watchful Waiting Versus Radical Surgery for Locally Advanced Rectal Cancer After Successful Neoadjuvant Chemoradiation

Annals of Surgical Oncology ◽

10.1245/s10434-021-10616-8 ◽

2021 ◽

Author(s):

Christina Liu Cui ◽

William Yu Luo ◽

Bard Clifford Cosman ◽

Samuel Eisenstein ◽

Daniel Simpson ◽

...

Keyword(s):

Rectal Cancer ◽

Cost Effectiveness ◽

Watchful Waiting ◽

Radical Surgery ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Neoadjuvant Chemoradiation ◽

The Cost

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QOLP-09. HEALTH ECONOMIC EVALUATION OF LOW-GRADE GLIOMA MANAGEMENT: A SYSTEMATIC REVIEW

Neuro-Oncology ◽

10.1093/neuonc/noaa215.734 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii176-ii176

Author(s):

Nima Hamidi ◽

Ajay Fernandez ◽

Kyle Tuohy ◽

Alireza Mansouri

Keyword(s):

Systematic Review ◽

Health Economic ◽

Cost Effectiveness ◽

Health Economics ◽

Surgical Resection ◽

Low Grade Glioma ◽

Low Grade ◽

Baseline Scenario ◽

Watch And Wait ◽

The Cost

Abstract BACKGROUND Diffuse low-grade gliomas (DLGGs, WHO Grade II gliomas) comprise 13-16% of all primary brain tumors. Although there has been a paradigmatic shift toward upfront maximal safe resection (MSR) for these heterogeneous tumors, it is important to consider the health economic perspective of this approach, compared with the traditional watch-and-wait approach, as well. OBJECTIVE To conduct a systematic review of the health economic literature on the range of DLGG management options. METHODS Following the PRISMA guidelines, Medline, EMBASE, The Central Registration Depository (CRD), EconPapers, and EconLit were searched for ‘cost-effectiveness’, ‘health economics’ and ‘Low-grade glioma’. Grade I tumors were excluded. Pre-specified variables were extracted. All currencies were converted to USD. RESULTS Among 258 abstracts, 28 were selected for full-text screening, and 3 were selected for this review. A European study evaluated the role of intraoperative electrical stimulation (IES). Although IES was associated with higher direct costs upfront ($38,662.70 vs $32,116.10), this was offset by less long-term indirect costs ($12,222.30 vs $31,927.10; p=0.023), greater QALY (4.8 vs 2.9; p=0.001), and an incremental cost-effectiveness ratio (ICER) of $1,842.50. Another study evaluated the cost-effectiveness of adjuvant PCV+RT vs RT alone, finding greater QALY for the former (9.94 vs 5.17) and an ICER of $10,186 per QALY gained. A third study evaluated the cost-effectiveness of adding 18F-fluoroethyl-L-tyrosine (FET) PET to MRI, compared to preoperative MRI alone. This resulted in an ICER of $7,193.58 for the baseline scenario (lowest reimbursement) and $10,236.12 for the morbidity-adjusted reimbursement rate scenario (highest reimbursement). There were no studies evaluating the health economics of maximal upfront surgical resection to the watch-and-wait approach. CONCLUSION We found a limited number of studies reporting on the health economics of DLGGs. Given the paradigmatic transition toward more aggressive upfront surgical resection, DLGG-specific health economic analyses are underway.

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Cost Effectiveness of Watch-and-Wait or Total Mesorectal Excision after Complete Clinical Response to Chemoradiotherapy for Rectal Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.06.2155 ◽

2019 ◽

Vol 105 (1) ◽

pp. E171

Author(s):

J.A. Miller ◽

H. Wang ◽

D.T. Chang ◽

E. Pollom

Keyword(s):

Rectal Cancer ◽

Cost Effectiveness ◽

Total Mesorectal Excision ◽

Clinical Response ◽

Complete Clinical Response ◽

Watch And Wait ◽

Mesorectal Excision

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Development and Validation of a Microsimulation Economic Model to Evaluate the Disease Burden Associated with Smoking and the Cost-Effectiveness of Tobacco Control Interventions in Latin America

Value in Health ◽

10.1016/j.jval.2011.05.010 ◽

2011 ◽

Vol 14 (5) ◽

pp. S51-S59 ◽

Cited By ~ 17

Author(s):

Andres Pichon-Riviere ◽

Federico Augustovski ◽

Ariel Bardach ◽

Lisandro Colantonio

Keyword(s):

Latin America ◽

Cost Effectiveness ◽

Tobacco Control ◽

Economic Model ◽

Disease Burden ◽

The Cost ◽

Development And Validation

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Cost-Utility Analysis of Preoperative Radiotherapy in Patients With Rectal Cancer Undergoing Total Mesorectal Excision: A Study of the Dutch Colorectal Cancer Group

Journal of Clinical Oncology ◽

10.1200/jco.2004.04.198 ◽

2004 ◽

Vol 22 (2) ◽

pp. 244-253 ◽

Cited By ~ 70

Author(s):

Mandy van den Brink ◽

Wilbert B. van den Hout ◽

Anne M. Stiggelbout ◽

Elma Klein Kranenbarg ◽

Corrie A.M. Marijnen ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Cost Effectiveness ◽

Life Expectancy ◽

Preoperative Radiotherapy ◽

Cost Utility ◽

Cost Effectiveness Ratio ◽

The Cost ◽

Quality Adjusted Life

Purpose To compare the societal costs and the (quality-adjusted) life expectancy of patients with rectal cancer undergoing total mesorectal excision (TME) with or without short-term preoperative radiotherapy (5 × 5 Gy). Patients and Methods We used a Markov model to project the clinical and economic outcomes of preoperative radiotherapy. Data on local recurrence rates, quality of life, and costs were obtained from the patients of a multicenter randomized clinical trial. In this trial, 1,861 patients with resectable rectal cancer from 108 hospitals were randomly assigned for TME surgery with or without preoperative radiotherapy. Outcome measures of the model were life expectancy, quality-adjusted life expectancy, lifetime costs per patient, and the incremental cost-effectiveness ratio. Results The base case model estimates that the loss of quality of life due to preoperative radiotherapy is outweighed by the gain in life expectancy. Life expectancy increases by 0.67 years; quality-adjusted life expectancy, by 0.39 years; and costs, by $9,800 per patient. The corresponding cost-effectiveness ratio is $25,100 per quality-adjusted life year. Sensitivity analyses indicate that the cost-effectiveness ratio remains acceptable under a wide range of assumptions. Conclusion Assuming that the reduced local recurrence rate does lead to a survival advantage, the cost-utility analysis estimates that the improved survival outweighs the impaired quality of life and the increased costs. We conclude that short-term preoperative radiotherapy in patients with rectal cancer undergoing TME is both effective and cost-effective.

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The Cost-Effectiveness Of Antenatal Syphilis Screening Using Point-Of-Care Testing In Latin America

Value in Health ◽

10.1016/j.jval.2014.03.932 ◽

2014 ◽

Vol 17 (3) ◽

pp. A160

Author(s):

H. Komakech ◽

C. Muhumuza ◽

M. Lamorde ◽

E. Marques ◽

A. Kuznik

Keyword(s):

Latin America ◽

Cost Effectiveness ◽

Point Of Care ◽

Point Of Care Testing ◽

Syphilis Screening ◽

The Cost

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Family planning programmes in ten developing countries: cost effectiveness by mode of service delivery

Journal of Biosocial Science ◽

10.1017/s0021932000017971 ◽

1989 ◽

Vol 21 (3) ◽

pp. 267-277 ◽

Cited By ~ 10

Author(s):

Sallie Craig Huber ◽

Philip D. Harvey

Keyword(s):

Developing Countries ◽

Latin America ◽

Cost Effectiveness ◽

Family Planning ◽

Service Delivery ◽

Family Planning Service ◽

Planning Service ◽

Community Based ◽

Distribution Services ◽

The Cost

SummaryThe cost effectiveness of various modes of family planning service delivery based on the cost per couple-year of protection (CYP) is assessed using 1984 data for 63 projects in ten countries (three each in Africa and Asia, and four in Latin America). More than 4·8 million CYPs were provided through these projects during the year studied. Programmes with the highest volume of services delivered corresponded to lowest average costs: social marketing (2·8 million CYPs) and sterilization projects (960,000 CYPs) cost about $2 per CYP, on average; highest costs were for full service clinics and community-based distribution projects ($13–14 per CYP). Costs of clinics combined with community-based distribution services fell approximately midway between these two extremes.

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Watch-and-wait policy versus robotic resection in locally advanced rectal cancer patients after clinical complete response following chemoradiotherapy: A cost-effectiveness study (RECCOSTE).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19374 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19374-e19374

Author(s):

Jesus Rodriguez-Pascual ◽

Javier Nuñez-Alfonsel ◽

Benedetto Ielpo ◽

Mercedes Lopez ◽

Rafael Alvarez-Gallego ◽

...

Keyword(s):

Rectal Cancer ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Locally Advanced ◽

Cost Savings ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Cost Utility ◽

Watch And Wait ◽

Cost Effective Treatment

e19374 Background: Chemoradiotheray (CR) followed by standard Surgical Resection (SR) is the standard treatment for distal locally-advanced rectal cancer (LARC) patients after a clinical compete response (cCR). Some novel approach suggested better functional results using robotic rectal resection (RRR) or avoiding surgical procedure, called Watch and Wait (WW) strategy. Methods: A Markov model-based, cost-utility analysis estimating mean costs and QALYs per patient was performed to compare SR, RRR and WW strategies for patients achieving a cCR to CRT. Rates of local regrowth, recurrence and distant metastasis were derived from series comparing WW to SR and from our previous comparative study of RRR versus SR. Lifetime incremental cost-utility ratio was calculated between strategies, and sensitivity analysis were performed to study model uncertainly. A willingness-to-pay of 30.000 per Quality Adjusted-Life Year (QALY) was used as a threshold to determine the most cost-effective treatment. Results: The base case 15-years cancer-specific survival was 93.5% (95% confidence interval [CI] 91.5-94.9] on a WW program, compared to 95.9% [95%CI 93.6-97.7] after RRR. WW was dominant relative to RRR with cost savings of $48,566.58 (95%CI $47,635.77 - $49,497.39 ) and incremental QALY of 7.47 (95%CI 1.46 – 7.48). WW was also dominant relative to LRR, with cost savings of $48,764.49 (95%CI $47,768.49 - $49,760.48 ) and incremental QALY of 7.44 (95%CI 7,43 – 7.45). WW remained dominant in sensitivity analysis unless the rate of SR fell to 73.0%). Conclusions: This study provides data of cost-effectiveness differences between SR, RRR, WW approaches in LARC after cCR, showing a benefit for WW.

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