Quality of life and cost effectiveness analysis of therapy for locally recurrent rectal cancer

PURPOSE: This study was performed to determine the quality of life and cost -effectiveness of therapeutic options for patients with locally recurrent r ectal carcinoma, determined from the perspectives of patients and health ca re providers. METHODS: We reviewed the records of patients (N = 68) with lo cally recurrent rectal carcinoma evaluated from 1992 through 1995. We const ructed a decision-analytic model incorporating outcomes, survival, and cost s. Utilities were elicited from convenience samples of health care provider s and patients using the standard gamble technique. RESULTS: The median sur vival for patients undergoing surgical resection (n = 40) was 42 months, co mpared with 16.8 months for patients undergoing diagnostic or palliative su rgery (n = 16) and 18.3 months for patients treated nonoperatively(n = 12; P < 0.005). The mean cost of treatment per patient was $19,283 for the nono perative group, $45,647 for the diagnostic or palliative surgery group, and $70,878 for the surgical resection group. The diagnostic or palliative sur gical strategy was dominated by the nonoperative strategy because the farme r had greater costs with fewer health benefits. The incremental cost-utilit y ratio of surgical resection compared with nonoperative management using h ealth care provider utilities was $109,777 per quality-adjusted life year g ained; it was reduced to $56,698 using per quality-adjusted life year using mean patient utilities. CONCLUSIONS: Patients with recurrent rectal carcin oma view surgery and morbidity to be less severe than health care providers . Diagnostic or palliative surgery is expensive and affects quality-adjuste d survival adversely compared with nonoperative therapy. Surgical resection may be a cost-effective use of resources, particularly when cost-effective ness is calculated using patient preferences.