Cost-effectiveness in the management of patients with oesophageal cancer

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Abstract
Background: The aim of this study was to assess the relationship between clinical outcome, quality of life and cost for treatment modalities commonly employed in the management of oesophageal carcinoma. Methods: A series of 51 patients diagnosed with oesophageal carcinoma in a 6-month period was used to derive a cost analysis profile for their treatment. All patients underwent quality of life assessment. Patients diagnosed in 1993 and managed in Newcastle upon Tyne were identified from the Northern Cancer Registry and Hospital Episode Statistics. Intervention profiles were documented for a 3-year follow-up period and cost analysis was conducted. A further 51 patients were recruited prospectively for quality-of-life studies. Results: Some 139 individuals were identified retrospectively. Median survival was significantly better in patients treated by resection (n = 31; median 20 months) than in those receiving palliative treatments (n = 108; median 6 months) (P < 0·0001). Median cost was significantly greater in individuals who underwent resection (£8070) than for patients subjected to a palliative strategy (radiotherapy £4720, brachytherapy £1790, laser £3540, intubation £2450, no treatment £1390) (P < 0·01). When considering the median cost per month of life (after treatment) resection (£457) compared favourably with the palliative options (range £342–1125). Conclusion: Surgical resection for oesophageal carcinoma confers greatest benefit in terms of survival. Costs are inherently greater in individuals undergoing resection but, allowing for time, resection is at least as cost-effective as other treatment modalities.