Cost-Effectiveness Analysis of Chemoradiotherapy Compared to Surgery in Patients with Stage I Esophageal Squamous Cell Carcinoma in Japan

Purpose We performed a model-based cost-effectiveness analysis of the use of surgical treatment (ST) versus chemoradiotherapy (CRT) for stage I esophageal cancer in Japan. Materials and Methods A model for partitioned survival analysis was developed to estimate the long-term medical costs and quality-adjusted life years (QALYs) for patients who had received either ST or CRT. Data on survival times were taken from the JCOG0502 trial. Utility values were estimated by applying a mapping algorithm based on Japanese data from the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. From the perspective of public healthcare, only direct medical costs were considered. A discount rate of 2% per year was applied to long-term costs and QALYs to estimate the incremental cost-effectiveness ratio (ICER) of CRT compared to ST. Results The incremental cost of CRT versus ST was estimated to be $26,313 (USD), the incremental QALY was 0.630, and the ICER was $41,742/QALY. Sensitivity analysis showed that the parameter with a relatively large effect on the ICER was the utility weight of progressive disease with esophagus preserved patients in CRT. The variations in ICERs ranged from approximately $37,113/QALY to $47,690/QALY. With willingness-to-pay thresholds ranging from $50,000/QALY to $100,000/QALY, CRT was more cost-effective than ST, with the probability of being cost-effective estimated to range from 59.3% to 76.3%. Conclusions In Japan, CRT for stage I esophageal cancer may be more cost-effective than ST, if the acceptable ICER is $50,000/QALY.