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01-11-2013 | Healthcare Policy and Outcomes

Cost-Effectiveness of Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

Authors: Lawrence Lee, MD, MSc, Monisha Sudarshan, MD, MPH, Chao Li, MD, MSc, Eric Latimer, PhD, Gerald M. Fried, MD, David S. Mulder, MD, Liane S. Feldman, MD, Lorenzo E. Ferri, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2013

Abstract

Background

A recent randomized trial comparing minimally invasive (MIE) and open esophagectomy for esophageal cancer reported improved short-term outcomes. However, MIE has increased operative costs, and it is unclear whether the short-term benefits of MIE outweigh the increased operative costs. Therefore, the objective of this study was to determine the cost-effectiveness of MIE compared to open esophagectomy for esophageal cancer.

Methods

A decision-analysis model was developed to estimate the expected costs and outcomes after MIE and open esophagectomy from a health care system perspective with a time horizon of 1 year. Costs were represented in 2012 Canadian dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). Probabilistic sensitivity analysis assessed parameter uncertainty.

Results

MIE was estimated to cost $1641 (95 % confidence interval 1565, 1718) less than open esophagectomy, with an incremental gain of 0.022 QALYs (95 % confidence interval 0.021, 0.023). MIE was therefore dominant over open esophagectomy. On deterministic sensitivity analyses, the results were most sensitive to variations in length of stay. Probabilistic sensitivity analysis demonstrated the robustness of the base case result, with 66, 77, and 82 % probabilities of cost-effectiveness at willingness-to-pay thresholds of $0/QALY, $50,000/QALY, and $100,000/QALY, respectively.

Conclusions

MIE is cost-effective compared to open esophagectomy in patients with resectable esophageal cancer.

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Title: Cost-Effectiveness of Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer
Authors: Lawrence Lee, MD, MSc
Monisha Sudarshan, MD, MPH
Chao Li, MD, MSc
Eric Latimer, PhD
Gerald M. Fried, MD
David S. Mulder, MD
Liane S. Feldman, MD
Lorenzo E. Ferri, MD, PhD
Publication date: 01-11-2013
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 12/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3103-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cost-Effectiveness of Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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