Cost-Effectiveness of Total Neoadjuvant Therapy With Selective Nonoperative Management for Locally Advanced Rectal Cancer: Analysis of Data From the Organ Preservation for Rectal Adenocarcinoma Trial.

IF 42.1 1区 医学 Q1 ONCOLOGY Journal of Clinical Oncology Pub Date : 2024-10-31 DOI:10.1200/JCO.24.00681
Maria Widmar, Mason McCain, Akriti Mishra Meza, Charles Ternent, Andrew Briggs, Julio Garcia-Aguilar
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Abstract

Purpose: The clinical efficacy of total neoadjuvant therapy (TNT) followed by selective nonoperative management (NOM) for locally advanced rectal cancer (LARC) was examined in the Organ Preservation for Rectal Adenocarcinoma (OPRA) trial. We investigated the cost and quality-of-life implications of adopting this treatment approach.

Methods: We analyzed clinical, cost, and quality-of-life outcomes for TNT with selective NOM in comparison with chemoradiotherapy (CRT)-surgery-adjuvant chemotherapy (standard of care [SOC]) using data from OPRA, prospective cohorts, and published studies. Cost-effectiveness was evaluated over varying willingness-to-pay thresholds, and sensitivity analyses evaluated cost-effectiveness for different surgical contexts and SOC variants as well as a 10-year time horizon.

Results: SOC was dominated by TNT with selective NOM in the base case analysis. TNT in which CRT was followed by consolidation chemotherapy (CNCT) was the least costly at $89,712 in Medicare proportionate US dollars (MP$), followed by TNT in which induction chemotherapy was followed by CRT (INCT) at MP$90,259 and SOC at MP$98,755. INCT was the preferred strategy, with 4.56 quality-adjusted life years, followed by CNCT at 4.42 and SOC at 4.29. TNT with selective NOM dominated SOC in all sensitivity analyses except when SOC omitted adjuvant chemotherapy without an impact on disease-free survival. CNCT was more cost effective than SOC when the proportion of patients entering NOM after TNT was ≥22% or ≥43%, for SOC with and without adjuvant therapy, both well below the rates seen in OPRA.

Conclusion: TNT with selective NOM is cost effective. The cost-effectiveness of CNCT with NOM relative to SOC is dependent on CNCT being made available to a sufficiently large proportion of patients with LARC. Additional analyses are needed to validate these findings from a societal perspective and in the context of other emerging treatment paradigms for LARC.

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局部晚期直肠癌新辅助治疗与选择性非手术治疗的成本效益:直肠腺癌器官保留试验数据分析》。
目的:在直肠腺癌器官保护(OPRA)试验中,研究了对局部晚期直肠癌(LARC)进行新辅助治疗(TNT)后选择性非手术治疗(NOM)的临床疗效。我们研究了采用这种治疗方法的成本和生活质量影响:我们利用 OPRA、前瞻性队列和已发表研究的数据,分析了选择性 NOM TNT 与化疗放疗 (CRT) - 手术辅助化疗(标准治疗 [SOC])的临床、成本和生活质量结果。根据不同的支付意愿阈值对成本效益进行了评估,敏感性分析评估了不同手术环境、SOC变体以及10年时间跨度的成本效益:在基础病例分析中,选择性 NOM 的 TNT 在 SOC 中占主导地位。在 TNT 中,CRT 后进行巩固化疗(CNCT)的成本最低,为 89,712 美元(按医疗保险美元比例计算),其次是诱导化疗后进行 CRT 的 TNT(INCT),为 90,259 美元,SOC 为 98,755 美元。INCT 是首选策略,质量调整生命年为 4.56,其次是 CNCT(4.42)和 SOC(4.29)。在所有敏感性分析中,选择性 NOM 的 TNT 均优于 SOC,除非 SOC 省略了辅助化疗,但对无病生存率没有影响。当TNT后进入NOM的患者比例≥22%或≥43%时,CNCT比SOC更具成本效益,SOC有辅助治疗和无辅助治疗的患者比例均远低于OPRA中的比例:带选择性NOM的TNT具有成本效益。与 SOC 相比,使用 NOM 的 CNCT 的成本效益取决于是否有足够大比例的 LARC 患者可以使用 CNCT。还需要进行更多的分析,以便从社会角度并结合其他新出现的 LARC 治疗范例来验证这些研究结果。
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来源期刊
Journal of Clinical Oncology
Journal of Clinical Oncology 医学-肿瘤学
CiteScore
41.20
自引率
2.20%
发文量
8215
审稿时长
2 months
期刊介绍: The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer.
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