Health Services Research
PV QA 3 - Poster Viewing Q&A 3
Purpose/Objective(s): Rectal cancer is a major cause of morbidity and mortality in the United States. Development and validation of newer technologies has made the treatment for locally advanced rectal cancer a moving target. Our group has demonstrated that short-course (SC) radiotherapy has better incremental net monetary benefit (NMB) than long-course (LC) chemoradiotherapy. The one-way sensitivity analysis of the base case scenario revealed that the 5-year probability of distant recurrence in LC and SC were the two most sensitive model parameters. We performed a threshold analysis to evaluate the degree by which prediction of distant recurrence will change the outcome of the incremental NMB.
Materials/Methods: A four state (no evidence of disease, local recurrence, distant recurrence, and death) Markov model with a 5-year time horizon was developed for this evaluation. Health outcomes and costs were discounted at 3% annually. The threshold analysis evaluated the percent change needed in distant recurrence probability for SC and LC to generate equal outcomes in terms of incremental NMB at a willingness-to-pay (WTP) of $150,000 per quality adjusted life year (QALY).
Results: At baseline, SC dominated LC, yielding 0.07 more life years and 0.08 QALYs while costing at least $23,000 less. The incremental NMB at baseline was over $34,000 in favor of SC at $150,000 per QALY WTP threshold. The 5-year distant recurrence probability in the LC arm required a 29% decrease for it to match the value of SC. This shift created slightly more QALYs for the LC arm as compared to the SC arm. Similarly, the 5-year distant recurrence probability in the SC arm required a 33% increase to generate equivalent treatment values. This adjustment also created slightly more QALYs for the LC arm. In both instances the costs for LC remained greater.
Conclusion: For LC to equal SC in terms of cost-effectiveness, the probability of distant recurrence in either arm would need to change by roughly 30%. The threshold analysis provides further evidence that SC is likely more cost-effective than LC. Future research should prioritize differentiating costs and outcomes of recurrence based on primary treatment.
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