EP364 - Total Pelvic Exenteration: A Cost-Effective Option for Locally Advanced and Recurrent Rectal Cancer?

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Purpose/Background: Background: Total pelvic exenteration (TPE) and chemoradiotherapy (CR) are the mainstay of treatment for locally advanced and recurrent rectal cancer. While TPE offers the potential for longer survival and improved quality of life, it comes at a higher cost. CR, although less expensive, may not achieve a complete cure and often results in a less favorable long-term outcome. The lack of robust cost-effectiveness analyses has hindered informed clinical decision-making, resulting in a suboptimal balance between cost and clinical outcomes.

Objective: The aim of this study is to determine the favored treatment for locally advanced or recurrent rectal cancer by comparing the cost-effectiveness of TPE or CR.

Methods/Interventions: We employed a Markov model to analyze the cost and economic outcomes of TPE and CR. The model incorporated three distinct states – progression-free survival, disease progression, and death – to simulate the survival trajectories of patients under both treatment strategies. The model cycle was set to 3 months, with time horizons of 1 year, 3 years, and 5 years. The primary outcome measures of the model were quality-adjusted life years (QALYs), lifetime costs per patient, and the incremental cost-effectiveness ratio (ICER).

Results/Outcomes: The TPE consistently demonstrated higher total costs and utility values compared to CR across model runs of 1 year, 3 years, and 5 years. Notably, the ICER values, calculated at ¥130212/QALY and ¥86268/QALY respectively, consistently fell below the willingness-to-pay (WTP) threshold. This highlights the potential cost-effectiveness advantage of TPE despite its higher initial cost. In the 5-year model run, the TPE incurred a total cost of ¥300787, yielding 3.81 QALYs. Conversely, the CR resulted in a total cost of ¥147755, but only yielded 1.71 QALYs. The ICER for CR versus TPE, calculated at ¥72,707/QALY, was substantially lower than the WTP. This further indicates that TPE becomes more cost-effective as survival duration increases. Sensitivity analyses confirmed the robustness of these findings, indicating that the conclusions were highly reliable.

Conclusion/Discussion: From a health economics perspective, TPE emerges as a more cost-effective treatment option for patients with locally advanced or recurrent rectal cancer, particularly for those with longer survival expectations. TPE offers a potentially better balance between cost and clinical outcomes. These findings provide a strong foundation for clinical decision-making in selecting appropriate treatment strategies for this complex disease while minimizing its economic burden.