{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T01:07:20Z","timestamp":1768266440616,"version":"3.49.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,7]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Locally advanced rectal cancer has high cure rates with trimodal therapy. Studies sparing neoadjuvant chemoradiation in selected patients show comparable outcomes.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE:<\/jats:title>\n This study aimed to determine the cost-effectiveness of selective use of neoadjuvant chemoradiation in this population.<\/jats:p>\n <\/jats:sec>\n \n DESIGN:<\/jats:title>\n A cost-effectiveness analysis model compared selective and blanket use chemoradiation for locally advanced rectal cancer.<\/jats:p>\n <\/jats:sec>\n \n SETTINGS:<\/jats:title>\n Literature review, expert consensus, and a prospective database populated the model. Health care utilization costs were based on information from the Centers for Medicare and Medicaid Services.<\/jats:p>\n <\/jats:sec>\n \n PATIENTS:<\/jats:title>\n Adult patients with stage II and III rectal cancer were selected.<\/jats:p>\n <\/jats:sec>\n \n MAIN OUTCOMES MEASURES:<\/jats:title>\n Primary outcomes were cost, effectiveness in quality-adjusted disease-free life years, net monetary benefit, and incremental cost-effectiveness ratios in dollars per quality-adjusted disease-free life years. Base-case 5-year disease-free survival for both strategies was 65%. One-way sensitivity analysis found the probability of 5-year disease-free survival for selective ranged between 40% and 65%. Probabilistic sensitivity analysis assessed second-order variability.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Base-case 5-year disease-free survival demonstrated selective use is dominant with lower cost and higher quality-adjusted disease-free life years. For selective use, cost is $153,176, effectiveness is 2.71 quality-adjusted life years, and net monetary benefit is \u2013$17,564 and for blanket use cost is $176,362, effectiveness is 2.64 quality-adjusted life years, and net monetary benefit is \u2013$44,217. One-way sensitivity analysis shows selective use is dominant for disease-free survival above 61.25% and is preferred for disease-free survival above 53.7%. Probabilistic sensitivity analysis shows selective use is optimal in 88% of the iterations for a population of 10,000 patients.<\/jats:p>\n <\/jats:sec>\n \n LIMITATIONS:<\/jats:title>\n Model was based on data from the literature, prospective database, and expert consensus.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n In a population of patients with locally advanced rectal cancer with base-case disease-free survival of 65%, selective use of neoadjuvant chemoradiation is the superior strategy as long as disease-free survival in this group remains above 53%. See Video Abstract<\/jats:bold> at http:\/\/links.lww.com\/DCR\/C199.<\/jats:p>\n <\/jats:sec>\n \n An\u00e1lisis De Costo-Efectividad: Uso Selectivo De Quimiorradiaci\u00f3n Neoadyuvante En C\u00e1ncer De Recto Localmente Avanzado<\/jats:title>\n \n ANTECEDENTES:<\/jats:bold>\n <\/jats:p>\n El c\u00e1ncer de recto localmente avanzado tiene altas tasas de curaci\u00f3n con la terapia trimodal. Los estudios que evitan la quimiorradiaci\u00f3n neoadyuvante en pacientes seleccionados muestran resultados comparables.<\/jats:p>\n \n OBJETIVO:<\/jats:bold>\n <\/jats:p>\n Determinar la relaci\u00f3n costo-efectividad del uso selectivo de quimiorradiaci\u00f3n neoadyuvante en esta poblaci\u00f3n.<\/jats:p>\n \n DISE\u00d1O:<\/jats:bold>\n <\/jats:p>\n Un modelo de an\u00e1lisis de costo-efectividad compar\u00f3 la quimiorradiaci\u00f3n selectiva y de uso general para el c\u00e1ncer de recto localmente avanzado.<\/jats:p>\n \n AJUSTES:<\/jats:bold>\n <\/jats:p>\n Revisi\u00f3n de literatura, consenso de expertos y una base de datos prospectiva poblaron el modelo. Los costos de utilizaci\u00f3n de la atenci\u00f3n m\u00e9dica se basaron en los Centros de Servicios de Medicare y Medicaid.<\/jats:p>\n \n PACIENTES:<\/jats:bold>\n <\/jats:p>\n Se seleccionaron pacientes adultos con c\u00e1ncer de recto en estadio II y III.<\/jats:p>\n \n PRINCIPALES MEDIDAS DE RESULTADOS:<\/jats:bold>\n <\/jats:p>\n Los resultados primarios fueron el costo, efectividad en a\u00f1os de vida sin enfermedad ajustados por calidad, el beneficio monetario neto y la relaci\u00f3n costo-efectividad incremental en $\/a\u00f1os de vida sin enfermedad ajustados por calidad. La supervivencia libre de enfermedad a 5 a\u00f1os del caso base para ambas estrategias fue del 65%. El an\u00e1lisis de sensibilidad unidireccional vari\u00f3 la probabilidad de supervivencia libre de enfermedad a 5 a\u00f1os para uso selectivo entre 40%\u201365%. El an\u00e1lisis de sensibilidad probabil\u00edstico evalu\u00f3 la variabilidad de segundo orden.<\/jats:p>\n \n RESULTADOS:<\/jats:bold>\n <\/jats:p>\n El caso base de 5 a\u00f1os de supervivencia libre de enfermedad demostr\u00f3 que el uso selectivo es dominante con menor costo y a\u00f1os de vida libre de enfermedad ajustados de mayor calidad. El costo, la efectividad y el beneficio monetario neto para el uso selectivo y general fueron ($153 176; 2,71 QALY; \u2013$17 564) y ($176 362; 2,64 QALY; \u2013$44 217). El an\u00e1lisis de sensibilidad unidireccional demostr\u00f3 que el uso selectivo es dominante para la supervivencia sin enfermedad por encima del 61,25% y se prefiere para la supervivencia sin enfermedad por encima del 53,7%. El an\u00e1lisis de sensibilidad probabil\u00edstico demostr\u00f3 que el uso selectivo es \u00f3ptimo en el 88% de las iteraciones para una poblaci\u00f3n de 10 000 pacientes.<\/jats:p>\n \n LIMITACIONES:<\/jats:bold>\n <\/jats:p>\n Modelo basado en datos de literatura, base de datos prospectiva y consenso de expertos.<\/jats:p>\n \n CONCLUSI\u00d3N:<\/jats:bold>\n <\/jats:p>\n En una poblaci\u00f3n de pacientes con c\u00e1ncer de recto localmente avanzado con caso base de supervivencia libre de enfermedad del 65%, el uso selectivo de quimiorradiaci\u00f3n neoadyuvante para el c\u00e1ncer de recto localmente avanzado es la estrategia superior, siempre y cuando la supervivencia libre de enfermedad en este grupo se mantenga por encima del 53%. Consulte Video Resumen<\/jats:bold> en http:\/\/links.lww.com\/DCR\/C199. (Traducci\u00f3n\u2014Dr. Fidel Ruiz Healy<\/jats:italic>)<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/dcr.0000000000002673","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T02:01:18Z","timestamp":1686708078000},"page":"946-956","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Cost-Effectiveness Analysis: Selective Use of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer"],"prefix":"10.1097","volume":"66","author":[{"given":"Andrew N.","family":"Mueller","sequence":"first","affiliation":[{"name":"Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Torgersen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Creighton University School of Medicine, Omaha, 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