Preoperative Radiation is a Cost-Effective Treatment for Rectal Cancer

Preoperative radiation therapy for rectal cancer is a cost-effective treatment strategy, according to the November 2002 issue of the International Journal of Radiation Oncology, Biology and Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology.

Many trials have demonstrated a reduction in local recurrence rates with preoperative radiation therapy in the treatment of rectal cancer, but it was not until the final report of the Swedish Rectal Cancer Trial in 1997 that radiation therapy plus surgery was also shown to significantly improve overall survival. These results have had a significant impact on the primary treatment of rectal cancer in Sweden and elsewhere. With the efficacy of this treatment established, researchers set out to determine cost-effectiveness by analyzing the direct healthcare costs to society of introducing preoperative radiation therapy in the primary treatment of operable rectal cancer.

After an eight-year follow-up, in-hospital and outpatient costs related to the treatment of rectal cancer and its complications were analyzed for 98 randomly allocated patients who participated in the Swedish Rectal Cancer Trial. The costs were then related to the clinical data from the original trial regarding complications, local and distant recurrences and survival.

Patients who received preoperative radiation therapy survived an average of 21 months longer than patients who did not receive radiation. To receive this added survival benefit of nearly two years, it only cost $5,188 more to treat a patient with surgery and radiation than with surgery alone.

"We found that the cost for a life-year saved was comparable with other well-accepted medical interventions," said Bengt Glimelius, M.D., Ph.D., of the Department of Oncology, Radiology and Clinical Immunology at Akademiska Sjukhuset in Uppsala, Sweden, and co-author of the study. "With rising health care costs becoming an issue of importance, this type of cost-effectiveness analysis is an important criterion in the decision of accepting preoperative radiation therapy as a valid treatment strategy. Our hope is that economic analyses such as this are a useful tool for making medical decisions more rational, controlling the escalating costs associated with new technologies and increasing efficiency in the healthcare system."