Originally published as JCO Early Release 10.1200/JCO.2004.04.198 on December 9 2003

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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

From the Department of Medical Decision Making, Department of Surgery, and Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands

Address reprint requests to W.B. van den Hout, PhD, Department of Medical Decision Making, J10-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: W.B.van_den_Hout{at}LUMC.NL

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 x 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.

This study was supported by grant 97-026 from the Health Care Insurance Board, the Hague, the Netherlands, and by grant CKVO 95-04 from the Dutch Cancer Society, Amsterdam, the Netherlands.

Presented in part at the 1^st Multidisciplinary Colorectal Cancer Congress, Noordwijk, the Netherlands, April 17–20, 2001. Participating investigators are listed in the Appendix.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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