Oncological Outcomes and Response Rate After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: A Network Meta-Analysis Comparing Induction vs. Consolidation Chemotherapy vs. Standard Chemoradiation

Bedrikovetski, Sergei; Traeger, Luke; Seow, Warren; Dudi-Venkata, Nagendra N.; Selva-Nayagam, Sudarsha; Penniment, Michael; Sammour, Tarik

doi:10.1016/j.clcc.2024.06.001

Clinical Colorectal Cancer

2024

DOI: 10.1016/j.clcc.2024.06.001

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Oncological Outcomes and Response Rate After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: A Network Meta-Analysis Comparing Induction vs. Consolidation Chemotherapy vs. Standard Chemoradiation

Sergei Bedrikovetski,

Luke Traeger,

Warren Seow

et al.

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2024

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Economic Evaluation of ‘Watch and Wait’ Following Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review

Murshed,

Bunjo,

Seow

et al. 2024

Ann Surg Oncol

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Background Owing to multimodal treatment and complex surgery, locally advanced rectal cancer (LARC) exerts a large healthcare burden. Watch and wait (W&W) may be cost saving by removing the need for surgery and inpatient care. This systematic review seeks to identify the economic impact of W&W, compared with standard care, in patients achieving a complete clinical response (cCR) following neoadjuvant therapy for LARC. Methods The PubMed, OVID Medline, OVID Embase, and Cochrane CENTRAL databases were systematically searched from inception to 26 April 2024. All economic evaluations (EEs) that compared W&W with standard care were included. Reporting and methodological quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), BMJ and Philips checklists. Narrative synthesis was performed. Primary and secondary outcomes were (incremental) cost-effectiveness ratios and the net financial cost. Results Of 1548 studies identified, 27 were assessed for full-text eligibility and 12 studies from eight countries (2016–2024) were included. Seven cost-effectiveness analyses (complete EEs) and five cost analyses (partial EEs) utilized model-based (n = 7) or trial-based (n = 5) analytics with significant variations in methodological design and reporting quality. W&W showed consistent cost effectiveness (n = 7) and cost saving (n = 12) compared with surgery from third-party payer and patient perspectives. Critical parameters identified by uncertainty analysis were rates of local and distant recurrence in W&W, salvage surgery, perioperative mortality and utilities assigned to W&W and surgery. Conclusion Despite heterogenous methodological design and reporting quality, W&W is likely to be cost effective and cost saving compared with standard care following cCR in LARC. Clinical Trials Registration PROSPERO CRD42024513874.

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Economic Evaluation of ‘Watch and Wait’ Following Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review

Murshed,

Bunjo,

Seow

et al. 2024

Ann Surg Oncol

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Oncological Outcomes and Response Rate After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: A Network Meta-Analysis Comparing Induction vs. Consolidation Chemotherapy vs. Standard Chemoradiation

Cited by 1 publication

References 56 publications

Economic Evaluation of ‘Watch and Wait’ Following Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review

Economic Evaluation of ‘Watch and Wait’ Following Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review

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