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Surveillance Intensity Comparison by Risk for T1NX Locally Excised Rectal Adenocarcinoma: a Cost-Effective Analysis

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Controversy exists regarding the optimal surveillance strategy following local excision of T1NX rectal adenocarcinoma. This study aims to determine the cost-effectiveness of surveillance strategies for locally excised T1NX rectal adenocarcinoma based on histopathologic and local staging risk factors.

Methods

A Markov model with 10-year follow-up was developed for cost-effectiveness analysis of high-, medium-, and low-intensity surveillance strategies after local excision of T1NX rectal adenocarcinoma. Literature review and expert consensus were utilized to populate state/transition probabilities and rewards. Based on this data, 87% of T1NX patients undergoing local excision were low risk. Healthcare utilization costs were based on Centers for Medicare and Medicaid Services data. The primary outcomes were costs in 2018 US dollars and effectiveness in life-years presented as net monetary benefit and incremental cost-effectiveness ratios. One-way sensitivity and probabilistic sensitivity analyses were performed.

Results

Net monetary benefit for low-, medium-, and high-intensity surveillance strategies ($393,117.00, $397,978.80, and $397,290.00) shows medium-intensity surveillance to be optimal. One-way sensitivity analysis shows medium-intensity surveillance to be optimal when the cohort is 73–94% low risk. High-intensity surveillance is preferred when less than 73% of the cohort is low risk. Low-intensity surveillance is preferred when greater than 94% is low risk. Probabilistic sensitivity analysis of the base-case shows medium-intensity surveillance is the optimal strategy for 51.5% of the iterations performed.

Conclusions

Medium-intensity surveillance is the most cost-effective surveillance strategy for locally excised T1NX rectal adenocarcinoma in a clinically representative population model.

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Author information

Authors and Affiliations

  1. Colon and Rectal Surgery Inc, Omaha, NE, USA

    Mason McCain, Yohanis O’Neill, Brian M. Sadowski, Zachary Torgersen, Jennifer Beaty & Charles A. Ternent

  2. Department of Surgery, Section of Colon and Rectal Surgery, Creighton University School of Medicine, Omaha, NE, USA

    Yohanis O’Neill, Brian M. Sadowski, Zachary Torgersen, Jennifer Beaty & Charles A. Ternent

  3. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA

    Hernan Hernandez, Brian M. Sadowski, Zachary Torgersen, Jennifer Beaty & Charles A. Ternent

  4. University of Kansas, Lawrence, KS, USA

    Ryan Foley

  5. School of Health and Related Research, Section of Health Economics and Decision Science, The University of Sheffield, Sheffield, UK

    Ruben Rojas Payacan

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Contributions

Mason McCain MA: conceptualization; data acquisition, analysis, and interpretation; model creation; model revisions; drafting manuscript; revising manuscript; project administration.

Yohanis O’Neill MD, MPH: conceptualization; design; revising manuscript.

Hernan Hernandez MD: data acquisition and analysis; revising manuscript.

Ryan Foley: data acquisition and analysis; revising manuscript.

Brian Sadowski MD: conceptualization; revising manuscript.

Zachary Torgersen MD: conceptualization; data acquisition, analysis, and interpretation; model revisions; drafting manuscript; revising manuscript; project administration.

Jennifer Beaty MD: conceptualization; analysis, and interpretation; revising manuscript.

Ruben Rojas Paycan MSc: conceptualization; analysis, and interpretation; revising manuscript.

Charles Ternent MD: conceptualization; data interpretation; model creation; model revisions; drafting manuscript; revising manuscript; project administration.

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The authors declare that they have no conflict of interest.

Additional information

Lecture presentation at the meeting of the Society for Surgery of the Alimentary Tract, San Diego, CA May 19, 2019.

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McCain, M., O’Neill, Y., Hernandez, H. et al. Surveillance Intensity Comparison by Risk for T1NX Locally Excised Rectal Adenocarcinoma: a Cost-Effective Analysis. J Gastrointest Surg 24, 198–208 (2020). https://doi.org/10.1007/s11605-019-04369-9

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