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TU_35_2939 - Threshold Analysis of a Cost-Effectiveness Study for Short-Course Radiation Therapy Compared to Long-Course Chemoradiotherapy in the Treatment of Stage III Rectal Cancer

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Threshold Analysis of a Cost-Effectiveness Study for Short-Course Radiation Therapy Compared to Long-Course Chemoradiotherapy in the Treatment of Stage III Rectal Cancer
B. G. Cohen1, J. Hay2, and A. Barzi3; 1University of Southern California, School of Pharmacy, Graduate Student, Los Angeles, CA, 2University of Southern California, Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, 3University of Southern California, Keck School of Medicine, Los Angeles, CA

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.

Author Disclosure: B.G. Cohen: None. J. Hay: None. A. Barzi: None.

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