Murshed Ishraq, Bunjo Zachary, Seow Warren, Murshed Ishmam, Bedrikovetski Sergei, Thomas Michelle, Sammour Tarik
Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.
Ann Surg Oncol. 2025 Jan;32(1):137-157. doi: 10.1245/s10434-024-16056-4. Epub 2024 Aug 24.
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.
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.
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.
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.
由于采用多模式治疗和复杂手术，局部晚期直肠癌（LARC）带来了巨大的医疗负担。观察等待（W&W）策略因无需手术和住院治疗，可能节省成本。本系统评价旨在确定在接受新辅助治疗后达到完全临床缓解（cCR）的LARC患者中，与标准治疗相比，观察等待策略的经济影响。
从数据库建库至2024年4月26日，对PubMed、OVID Medline、OVID Embase和Cochrane CENTRAL数据库进行系统检索。纳入所有比较观察等待与标准治疗的经济评估（EEs）。使用《卫生经济评估报告标准合并版》（CHEERS）、《英国医学杂志》和飞利浦清单评估报告和方法学质量。进行叙述性综合分析。主要和次要结局为（增量）成本效益比和净财务成本。
在检索到的1548项研究中，27项被评估全文是否符合纳入标准，最终纳入来自8个国家的12项研究（2016 - 2024年）。七项成本效益分析（完整EEs）和五项成本分析（部分EEs）采用基于模型（n = 7）或基于试验（n = 5）的分析方法，方法学设计和报告质量存在显著差异。从第三方支付者和患者角度来看，与手术相比，观察等待显示出一致的成本效益（n = 7）和成本节约（n = 12）。不确定性分析确定的关键参数为观察等待中的局部和远处复发率、挽救性手术、围手术期死亡率以及赋予观察等待和手术的效用值。
尽管方法学设计和报告质量存在异质性，但在LARC患者达到cCR后，与标准治疗相比，观察等待可能具有成本效益且能节省成本。临床试验注册号：PROSPERO CRD42024513874。
