{"title":"直肠癌的全面新辅助治疗与传统新辅助治疗:公共卫生系统的成本分析。","authors":"Ishraq Murshed, Sergei Bedrikovetski, Ishmam Murshed, Zachary Bunjo, Tracy Fitzsimmons, Michelle Thomas, Tarik Sammour","doi":"10.1111/ans.70169","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Total neoadjuvant therapy (TNT) has become the standard of care in locally advanced rectal cancer, but its economic impact is unclear. This study compares the cost of TNT with conventional neoadjuvant therapy (CNT), consisting of either short-course radiotherapy or long-course chemoradiotherapy, within a universally funded public healthcare system.</p><p><strong>Methodology: </strong>A trial-based costing analysis was conducted from a third-party payer's perspective with a 2-year time horizon, following CHEERS guidelines. Consecutive patients with rectal cancer treated with neoadjuvant therapy from 2014 to 2023 were extracted from a multi-institutional database. Inpatient, outpatient, imaging and pathology resource costs were extracted and adjusted to 2024 AUD with a 5% discount rate. Primary outcomes were overall cost per cohort and mean per patient cost. Secondary outcomes were overall and mean cost per cost category. Sensitivity analysis explored the influence of discount rates and inflation methods.</p><p><strong>Results: </strong>Of 115 eligible patients, 60 (52.2%) received CNT and 55 (47.8%) received TNT. Overall treatment costs for the cohorts were $8 429 710.66 (CNT) and $6 992 616.67 (TNT), with mean per patient costs of $140 495.18 (CNT) and $127 138.48 (TNT). Overall per patient costs were $13 356.70 (9.51%) lower for TNT patients, mainly driven by lower mean inpatient costs ($78 523.53 vs. $96 843.08, 18.9%). TNT increased outpatient ($43 001.18 vs. $39 376.12, 9.21%), imaging ($4179.13 vs. $2973.61, 40.5%) and pathology ($1434.65 vs. $1302.38, 10.1%) costs. The results were robust to sensitivity analysis.</p><p><strong>Conclusion: </strong>TNT is less costly than CNT within a universally funded public healthcare system, primarily due to reduced inpatient costs associated with higher rates of organ preservation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Therapy for Rectal Cancer: Cost Analysis in a Public Healthcare System.\",\"authors\":\"Ishraq Murshed, Sergei Bedrikovetski, Ishmam Murshed, Zachary Bunjo, Tracy Fitzsimmons, Michelle Thomas, Tarik Sammour\",\"doi\":\"10.1111/ans.70169\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Total neoadjuvant therapy (TNT) has become the standard of care in locally advanced rectal cancer, but its economic impact is unclear. This study compares the cost of TNT with conventional neoadjuvant therapy (CNT), consisting of either short-course radiotherapy or long-course chemoradiotherapy, within a universally funded public healthcare system.</p><p><strong>Methodology: </strong>A trial-based costing analysis was conducted from a third-party payer's perspective with a 2-year time horizon, following CHEERS guidelines. Consecutive patients with rectal cancer treated with neoadjuvant therapy from 2014 to 2023 were extracted from a multi-institutional database. Inpatient, outpatient, imaging and pathology resource costs were extracted and adjusted to 2024 AUD with a 5% discount rate. Primary outcomes were overall cost per cohort and mean per patient cost. Secondary outcomes were overall and mean cost per cost category. Sensitivity analysis explored the influence of discount rates and inflation methods.</p><p><strong>Results: </strong>Of 115 eligible patients, 60 (52.2%) received CNT and 55 (47.8%) received TNT. Overall treatment costs for the cohorts were $8 429 710.66 (CNT) and $6 992 616.67 (TNT), with mean per patient costs of $140 495.18 (CNT) and $127 138.48 (TNT). Overall per patient costs were $13 356.70 (9.51%) lower for TNT patients, mainly driven by lower mean inpatient costs ($78 523.53 vs. $96 843.08, 18.9%). TNT increased outpatient ($43 001.18 vs. $39 376.12, 9.21%), imaging ($4179.13 vs. $2973.61, 40.5%) and pathology ($1434.65 vs. $1302.38, 10.1%) costs. The results were robust to sensitivity analysis.</p><p><strong>Conclusion: </strong>TNT is less costly than CNT within a universally funded public healthcare system, primarily due to reduced inpatient costs associated with higher rates of organ preservation.</p>\",\"PeriodicalId\":8158,\"journal\":{\"name\":\"ANZ Journal of Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-05-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ANZ Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/ans.70169\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ANZ Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ans.70169","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Therapy for Rectal Cancer: Cost Analysis in a Public Healthcare System.
Purpose: Total neoadjuvant therapy (TNT) has become the standard of care in locally advanced rectal cancer, but its economic impact is unclear. This study compares the cost of TNT with conventional neoadjuvant therapy (CNT), consisting of either short-course radiotherapy or long-course chemoradiotherapy, within a universally funded public healthcare system.
Methodology: A trial-based costing analysis was conducted from a third-party payer's perspective with a 2-year time horizon, following CHEERS guidelines. Consecutive patients with rectal cancer treated with neoadjuvant therapy from 2014 to 2023 were extracted from a multi-institutional database. Inpatient, outpatient, imaging and pathology resource costs were extracted and adjusted to 2024 AUD with a 5% discount rate. Primary outcomes were overall cost per cohort and mean per patient cost. Secondary outcomes were overall and mean cost per cost category. Sensitivity analysis explored the influence of discount rates and inflation methods.
Results: Of 115 eligible patients, 60 (52.2%) received CNT and 55 (47.8%) received TNT. Overall treatment costs for the cohorts were $8 429 710.66 (CNT) and $6 992 616.67 (TNT), with mean per patient costs of $140 495.18 (CNT) and $127 138.48 (TNT). Overall per patient costs were $13 356.70 (9.51%) lower for TNT patients, mainly driven by lower mean inpatient costs ($78 523.53 vs. $96 843.08, 18.9%). TNT increased outpatient ($43 001.18 vs. $39 376.12, 9.21%), imaging ($4179.13 vs. $2973.61, 40.5%) and pathology ($1434.65 vs. $1302.38, 10.1%) costs. The results were robust to sensitivity analysis.
Conclusion: TNT is less costly than CNT within a universally funded public healthcare system, primarily due to reduced inpatient costs associated with higher rates of organ preservation.
期刊介绍:
ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.