SP6.4 Economic cost-utility analysis of stage-directed oesophageal cancer treatment
Geraint Herbert, Emma Barlow, Catherine Eley, David Robinson, Arfon Powell, Wyn Lewis- Surgery
Abstract
Aims
Oesophageal Cancer (OC) treatment levies substantial financial burden on health services with potentially curative surgery with or without neoadjuvant offered to patients with locoregional disease. This study aimed to examine treatment costs related to Quality Adjusted Life-Years (QALYs) gained in patients that have potentially curative treatment (oesophagectomy) and those receiving best supportive care (BSC).
Methods
Consecutive 365 patients undergoing potentially curative treatment (median age 64.5 years, 308 male, 57 female, 331 adeno ca, 32 squamous cell ca, 2 high grade dysplasia, 263 neoadjuvant therapy) were studied. The cost of one-year’s treatment from referral was calculated based on current management standards within a regional cancer network and primary outcome was overall survival.
Results
QALY-adjusted survival for stage I was 48 months, stage II 30.6 months, stage III 23.0 months, and stage IV 13.0 months, with cost per QALY of £6038, £13412, £14606, and £20002 respectively. QALY-adjusted survival for patients receiving BSC was 2.24 months, with a cost per QALY of £60225. This gives an Incremental Cost-Effectiveness Ratio (ICER) per QALY for stages I to IV of £3385, £9714, £8740 and £17763 respectively.
Conclusion
Cost per QALY of potentially curative OC treatment for each stage was below national thresholds of readiness to pay per QALY, while BSC likely exceeds this. Regarding ICER-defined cost effectiveness, treatment of stage I was five-fold cheaper than stage IV OC, supporting early diagnosis as being most cost-effective.