Cost-effectiveness analysis of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced esophageal squamous cell carcinoma based on the NEOCRTEC5010 trial

Background and purpose: The phase 3 NEOCRTEC5010 trial demonstrated that neoadjuvant chemoradiotherapy (NCRT) plus surgery for locally advanced esophageal squamous cell carcinoma (ESCC) had significantly greater efficacy than surgery alone did, but at the same time, the addition of NCRT places an economic burden on patients. This study assessed the cost-effectiveness of NCRT followed by surgery based on the NEOCRTEC5010 trial. Materials and methods: A three-state Markov model (disease-free survival, relapse and death) based on data from the NEOCRTEC5010 trial was used to estimate the incremental cost-effectiveness ratio (ICER) of NCRT plus surgery versus surgery alone for ESCC. The model evaluates the outcomes from the perspective of Chinese society. Costs, quality-adjusted life-years (QALYs), and the ICER in terms of 2019 US$ per QALY gained, were calculated. Model robustness was evaluated with one-way and probabilistic sensitivity analyses. Results: Compared with surgery alone, NCRT plus surgery increased costs by $14933.57, while gaining 3.08 QALYs, resulting in an ICER of $4848.56 per QALY. The ICER was far below the commonly accepted willingness-to-pay threshold ($26,157 per QALY). The duration of disease-free survival (DFS) for the group that received NCRT was the crucial factor in determining the ICER. Conclusion: Compared with surgery alone, NCRT followed by surgery for locally advanced ESCC can be cost-effective because of significant clinical benefits. (C) 2019 Elsevier B.V. All rights reserved.