Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer
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Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer. / Wurschi, Georg W; Rühle, Alexander; Domschikowski, Justus; Trommer, Maike; Ferdinandus, Simone; Becker, Jan-Niklas; Boeke, Simon; Sonnhoff, Mathias; Fink, Christoph A; Käsmann, Lukas; Schneider, Melanie; Bockelmann, Elodie; Krug, David; Nicolay, Nils H; Fabian, Alexander; Pietschmann, Klaus.
In: CANCERS, Vol. 16, No. 7, 1281, 26.03.2024.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer
AU - Wurschi, Georg W
AU - Rühle, Alexander
AU - Domschikowski, Justus
AU - Trommer, Maike
AU - Ferdinandus, Simone
AU - Becker, Jan-Niklas
AU - Boeke, Simon
AU - Sonnhoff, Mathias
AU - Fink, Christoph A
AU - Käsmann, Lukas
AU - Schneider, Melanie
AU - Bockelmann, Elodie
AU - Krug, David
AU - Nicolay, Nils H
AU - Fabian, Alexander
AU - Pietschmann, Klaus
PY - 2024/3/26
Y1 - 2024/3/26
N2 - Total neoadjuvant therapy (TNT) is an evolving treatment schedule for locally advanced rectal cancer (LARC), allowing for organ preservation in a relevant number of patients in the case of complete response. Patients who undergo this so-called "watch and wait" approach are likely to benefit regarding their quality of life (QoL), especially if definitive ostomy could be avoided. In this work, we performed the first cost-effectiveness analysis from the patient perspective to compare costs for TNT with radical resection after neoadjuvant chemoradiation (CRT) in the German health care system. Individual costs for patients insured with a statutory health insurance were calculated with a Markov microsimulation. A subgroup analysis from the prospective "FinTox" trial was used to calibrate the model's parameters. We found that TNT was less expensive (-1540 EUR) and simultaneously resulted in a better QoL (+0.64 QALYs) during treatment and 5-year follow-up. The average cost for patients under TNT was 4711 EUR per year, which was equivalent to 3.2% of the net household income. CRT followed by resection resulted in higher overall costs for ostomy care, medication and greater loss of earnings. Overall, TNT appeared to be more efficacious and cost-effective from a patient's point of view in the German health care system.
AB - Total neoadjuvant therapy (TNT) is an evolving treatment schedule for locally advanced rectal cancer (LARC), allowing for organ preservation in a relevant number of patients in the case of complete response. Patients who undergo this so-called "watch and wait" approach are likely to benefit regarding their quality of life (QoL), especially if definitive ostomy could be avoided. In this work, we performed the first cost-effectiveness analysis from the patient perspective to compare costs for TNT with radical resection after neoadjuvant chemoradiation (CRT) in the German health care system. Individual costs for patients insured with a statutory health insurance were calculated with a Markov microsimulation. A subgroup analysis from the prospective "FinTox" trial was used to calibrate the model's parameters. We found that TNT was less expensive (-1540 EUR) and simultaneously resulted in a better QoL (+0.64 QALYs) during treatment and 5-year follow-up. The average cost for patients under TNT was 4711 EUR per year, which was equivalent to 3.2% of the net household income. CRT followed by resection resulted in higher overall costs for ostomy care, medication and greater loss of earnings. Overall, TNT appeared to be more efficacious and cost-effective from a patient's point of view in the German health care system.
U2 - 10.3390/cancers16071281
DO - 10.3390/cancers16071281
M3 - SCORING: Journal article
C2 - 38610958
VL - 16
JO - CANCERS
JF - CANCERS
SN - 2072-6694
IS - 7
M1 - 1281
ER -