Cost analysis of a watch‐and‐wait approach in patients with a complete clinical response to chemoradiotherapy for rectal cancer

Abstract

Background: There is increasing interest in the watch-and-wait approach for patients with rectal cancer who have had a complete clinical response following neoadjuvant long course chemoradiotherapy. This study is a cost analysis of expenditure on patients in the watchand-wait program versus patients who underwent standard rectal resection followed by routine surveillance. Methods: Data were prospectively collated and retrospectively analysed in all patients who presented with rectal cancer from January 2016 to January 2018 at Sir Charles Gairdner Hospital, Perth, Western Australia. Software developed by the North Metropolitan Health Service was used to capture comprehensive data to calculate the in-hospital expenditure for an individual patient throughout their treatment journey. Results: For a patient enrolled in the watch-and-wait pathway, the total cost of surveillance over a 5-year period was $45 246. This was compared with the cost of an ultra-low anterior resection/loop ileostomy/closure of loop and routine postoperative surveillance which came to a total of $87 473. While a patient who had an abdominoperineal resection followed by routine 5-year surveillance had an expenditure of $82 290. Conclusion: There is growing evidence that the watch-and-wait strategy is a valid management option. In the cost-conscious environment of the current health care system, the watch-and-wait pathway is a cost-effective and economically advantage treatment.

Comparing outcomes and cost in surgery versus watch & wait surveillance of patients with rectal cancer post neoadjuvant long course chemoradiotherapy

“…A 2022 Australian paper 17 estimated and compared the costs of both treatments. Based on a model follow‐up protocol with intensive surveillance, that is, three‐monthly flexible sigmoidoscopies and four monthly MRIs in the first year – an expected cost was generated at $34 840 (AUD).…”

“…In W&W, intensive surveillance similarly generates costs for endoscopic, radiologic and clinical re‐evaluation and similar costs to the TME group in the event of local regrowth and salvage surgery. Early studies suggested that surveillance would be more cost‐effective than surgery, this was initially based on hypothetical models, 14–16 and cost reduction appears to be borne out in recent clinical studies in certain health systems 17,18 …”

“…Early studies suggested that surveillance would be more cost-effective than surgery, this was initially based on hypothetical models, [14][15][16] and cost reduction appears to be borne out in recent clinical studies in certain health systems. 17,18 We hypothesised that those undergoing surgical treatment (OT) would have more frequent and severe complications, more bed days and higher costs associated more complications. We aimed to benchmark our oncological and operative outcomes against international standards and assess the costs of both strategies in a tertiary New Zealand centre to provide real-world dollar amounts.…”

Application of multimodal identification technology in the innovative management operation department

“…Traditional group (control group): The traditional group uses traditional manual surgery management, including manual ordering before surgery, taking patients from the ward to the operating department, and then connecting to the operating room, manual arrangement of surgical laparoscopic equipment, and no nodes for the circulation and use of surgical equipment. After the patients were returned to the ward after surgery, the researchers collected data from multiple links and manually analyzed the relevant factors that restricted efficiency (17).…”