Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer

Georg W Wurschi; Alexander Rühle; Justus Domschikowski; Maike Trommer; Simone Ferdinandus; Jan-Niklas Becker; Simon Boeke; Mathias Sonnhoff; Christoph A Fink; Lukas Käsmann; Melanie Schneider; Elodie Bockelmann; David Krug; Nils H Nicolay; Alexander Fabian; Klaus Pietschmann

doi:10.3390/cancers16071281

Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer

Cancers (Basel). 2024 Mar 26;16(7):1281. doi: 10.3390/cancers16071281.

Authors

Georg W Wurschi^{1

2

3}, Alexander Rühle^{4

5

6}, Justus Domschikowski⁷, Maike Trommer^{8

9}, Simone Ferdinandus^{8

10}, Jan-Niklas Becker¹¹, Simon Boeke¹², Mathias Sonnhoff^{11

13}, Christoph A Fink¹⁴, Lukas Käsmann^{15

16

17}, Melanie Schneider¹⁸, Elodie Bockelmann¹⁹, David Krug⁷, Nils H Nicolay^{5

6}, Alexander Fabian⁷, Klaus Pietschmann^{1

3}

Affiliations

¹ Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07747 Jena, Germany.
² Clinician Scientist Program, Interdisciplinary Center for Clinical Research (IZKF), Jena University Hospital, 07747 Jena, Germany.
³ Cancer Center Central Germany (CCCG), 07747 Jena, Germany.
⁴ Department of Radiation Oncology, University of Freiburg-Medical Center, 79106 Freiburg, Germany.
⁵ Department of Radiation Oncology, University of Leipzig Medical Center, 04103 Leipzig, Germany.
⁶ Cancer Center Central Germany (CCCG), 04103 Leipzig, Germany.
⁷ Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
⁸ Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany.
⁹ Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany.
¹⁰ Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Düsseldorf (CIO ABCD), 50937 Cologne, Germany.
¹¹ Department of Radiotherapy, Hannover Medical School, 30625 Hannover, Germany.
¹² Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany.
¹³ Center for Radiotherapy and Radiation Oncology, 28239 Bremen, Germany.
¹⁴ Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany.
¹⁵ Department of Radiation Oncology, University Hospital, LMU Munich, 81377 Munich, Germany.
¹⁶ Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), 81377 Munich, Germany.
¹⁷ German Cancer Consortium (DKTK), Partner Site Munich, 81377 Munich, Germany.
¹⁸ Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, 01307 Dresden, Germany.
¹⁹ Department of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany.

Abstract

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.

Keywords: cost-effectiveness; financial toxicity; rectal cancer; total neoadjuvant therapy; watch and wait.

Grants and funding

This research received no external funding. We acknowledge support for APC by the German Research Foundation Projekt-Nr. 512648189 and the Open Access Publication Fund of the Thueringer Universitaets- und Landesbibliothek Jena.