The following is a summary of the “How Far Is Too Far? Cost-Effectiveness Analysis of Regionalized Rectal Cancer Surgery,” published in the March 2023 issue of Colon & Rectum by Leeds, et al.
The purpose of this research was to determine whether or not regionalized rectal cancer surgery is financially viable. Analysis of alternatives using trees. Patients were included if they had rectal cancer and were at a stage where low anterior resection was an option due to their anatomy. High-volume regional centre rather than the nearest hospital for rectal cancer surgery. Both the incremental cost ($) and efficacy (QALY) were discounted over time at 3% to reflect a societal perspective. The incremental cost-effectiveness ratio ($ per quality-adjusted life year) was calculated by factoring in both costs and benefits. Probabilistic sensitivity analysis with several variables was used to simulate unknowns in probability, cost, and efficiency.
In terms of cost, regionalized surgery has supplanted its local counterpart. On average, the cost of regionalized rectal cancer surgery was $50,406, which is significantly cheaper than the current rate of $65,430 per procedure (10.36 versus 9.51 quality-adjusted life years). A patient would have to spend more than $15,024 on transportation to a regional high-volume centre before they would break even financially, and they would have to spend at least $112,476 to meet traditional cost-effectiveness benchmarks.
The outcomes held up in 94.6% of tested scenarios, and the sensitivity analysis confirmed their reliability. The models used in decision analysis can only be applied at the policy level, not the individual level. When comparing regionalized surgery for rectal cancer to local surgery, better clinical outcomes are achieved at lower total societal expenditures. In order to increase the use of regionalized surgery for rectal cancer, perhaps prescriptive measures and patient incentives are required.