Díaz José Fernando Robles, Changra Henry Olivera
Regional Institute of Neoplastic Diseases of the Center, Concepción, Junín 12126, Peru.
Los Andes Peruvian University, Huancayo, Junín 12002, Peru.
Ecancermedicalscience. 2022 Jun 7;16:1406. doi: 10.3332/ecancer.2022.1406. eCollection 2022.
Conventional long-course radiotherapy (LCRT) and a new paradigm of short-course radiotherapy with total neoadjuvant therapy (SCRT-TNT) are used in locally advanced rectal cancer (RC). There are few economic assessment reports available on TNT that focus on cost analysis in a country with limited funding for healthcare systems. The objective of this study was to perform a cost analysis comparing SCRT-TNT versus LCRT.
In 2020-2021, a prospective registry was created to document RC patients who received neoadjuvant therapy and the costs of cancer treatments, transportation and the time patients and family members spent in the hospital. This registry outlined the direct and indirect costs of LCRT versus SCRT-TNT.
LCRT and SCRT-TNT regimens have direct costs that range from S/.5,993.30 to S/.27,928.36 and from S/.3,409.81 to S/.18,159.42, respectively. FOLFOX regimens are the most expensive. Administering radiotherapy in 28 3D sessions and 5 sessions of intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) sessions costs S/.2,603.88, S/.1,277.19 and S/.1,027.77, respectively. The indirect cost of FOLFOX regimens is twice that of the similar modality that combines irradiation and Oxaliplatin IV and Capecitabine VO (CAPOX). SCRT-TNT regimens with CAPOX reduce costs by at least 50%, while SCRT-TNT regimens with FOLFOX reduce costs by 32%.
Despite using IMRT/VMAT, SCRT-TNT is a less expensive approach for patients with RC when compared to LCRT. The costs to patients using SCRT-TNT are much lower, but it is also a better option because it saves hospital resources.
传统的长程放疗（LCRT）以及一种新的短程放疗联合全新辅助治疗（SCRT-TNT）模式应用于局部晚期直肠癌（RC）。关于新辅助治疗（TNT）的经济评估报告较少，且很少有聚焦于医疗保健系统资金有限国家的成本分析。本研究的目的是对SCRT-TNT与LCRT进行成本分析比较。
在2020年至2021年期间，创建了一个前瞻性登记系统，记录接受新辅助治疗的RC患者以及癌症治疗、交通费用，还有患者及其家庭成员在医院花费的时间。该登记系统概述了LCRT与SCRT-TNT的直接和间接成本。
LCRT和SCRT-TNT方案的直接成本分别为5993.30秘鲁新索尔至27928.36秘鲁新索尔以及3409.81秘鲁新索尔至18159.42秘鲁新索尔。FOLFOX方案最为昂贵。进行28次三维放疗以及5次调强放疗（IMRT）或容积调强弧形放疗（VMAT）的费用分别为2603.88秘鲁新索尔、1277.19秘鲁新索尔和1027.77秘鲁新索尔。FOLFOX方案的间接成本是联合放疗及静脉注射奥沙利铂和口服卡培他滨（CAPOX）类似方案的两倍。采用CAPOX的SCRT-TNT方案至少降低成本50%，而采用FOLFOX的SCRT-TNT方案降低成本32%。
尽管使用了IMRT/VMAT，但与LCRT相比，SCRT-TNT对RC患者来说是一种成本更低的方法。使用SCRT-TNT的患者成本要低得多，而且它也是更好的选择，因为它节省了医院资源。
