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The cost-effectiveness of neoadjuvant chemoradiation is superior to a surgery-first approach in the treatment of pancreatic head adenocarcinoma.

Publication ,  Journal Article
Abbott, DE; Tzeng, C-WD; Merkow, RP; Cantor, SB; Chang, GJ; Katz, MH; Bentrem, DJ; Bilimoria, KY; Crane, CH; Varadhachary, GR; Abbruzzese, JL ...
Published in: Ann Surg Oncol
December 2013

BACKGROUND: In treating pancreatic cancer, there is no clearly defined optimal sequence of chemotherapy, radiation therapy and surgery. Therefore, cost-effectiveness should be considered. The objective of this study was to compare cost and outcomes between a surgery-first approach versus neoadjuvant chemoradiation followed by surgery for resectable pancreatic head cancer. METHODS: A decision analytic model was constructed to compare the 2 approaches. Data from the National Cancer Database, National Surgical Quality Improvement Program, and literature populated the surgery-first arm. Data from our prospectively maintained institutional pancreatic cancer database populated the neoadjuvant arm. Costs were estimated by Medicare payment (2011 U.S. dollars). Survival was reported in quality-adjusted life-months (QALMs). RESULTS: The neoadjuvant chemoradiation arm consisted of 164 patients who completed preoperative therapy. Of these, 36 (22 %) did not proceed to surgery; 12 (7 %) underwent laparotomy but had unresectable disease; and 116 (71 %) underwent definitive resection. The surgery-first approach cost $46,830 and yielded survival of 8.7 QALMs; the neoadjuvant chemoradiation approach cost $36,583 and yielded survival of 18.8 QALMs. In the neoadjuvant arm, costs and survival times for patients not undergoing surgery, those with unresectable disease at laparotomy, and those completing surgery were $12,401 and 7.7 QALMs, $20,380 and 7.1 QALMs, and $45,673 and 23.4 QALMs, respectively. CONCLUSIONS: Neoadjuvant chemoradiation for pancreatic cancer identifies patients with early metastases or poor performance status, who can be spared an ineffective or prohibitively morbid operation, and is associated with improved survival at significantly lower cost than a surgery-first approach. Neoadjuvant chemoradiation followed by surgery is a strategy that provides more cost-effective care than a surgery-first approach.

Duke Scholars

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

December 2013

Volume

20 Suppl 3

Start / End Page

S500 / S508

Location

United States

Related Subject Headings

  • Survival Rate
  • Radiotherapy, Adjuvant
  • Quality-Adjusted Life Years
  • Prospective Studies
  • Prognosis
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoadjuvant Therapy
 

Citation

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ICMJE
MLA
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Abbott, D. E., Tzeng, C.-W., Merkow, R. P., Cantor, S. B., Chang, G. J., Katz, M. H., … Fleming, J. B. (2013). The cost-effectiveness of neoadjuvant chemoradiation is superior to a surgery-first approach in the treatment of pancreatic head adenocarcinoma. Ann Surg Oncol, 20 Suppl 3, S500–S508. https://doi.org/10.1245/s10434-013-2882-0
Abbott, Daniel E., Ching-Wei David Tzeng, Ryan P. Merkow, Scott B. Cantor, George J. Chang, Matthew Harold Katz, David J. Bentrem, et al. “The cost-effectiveness of neoadjuvant chemoradiation is superior to a surgery-first approach in the treatment of pancreatic head adenocarcinoma.Ann Surg Oncol 20 Suppl 3 (December 2013): S500–508. https://doi.org/10.1245/s10434-013-2882-0.
Abbott DE, Tzeng C-WD, Merkow RP, Cantor SB, Chang GJ, Katz MH, et al. The cost-effectiveness of neoadjuvant chemoradiation is superior to a surgery-first approach in the treatment of pancreatic head adenocarcinoma. Ann Surg Oncol. 2013 Dec;20 Suppl 3:S500–8.
Abbott, Daniel E., et al. “The cost-effectiveness of neoadjuvant chemoradiation is superior to a surgery-first approach in the treatment of pancreatic head adenocarcinoma.Ann Surg Oncol, vol. 20 Suppl 3, Dec. 2013, pp. S500–08. Pubmed, doi:10.1245/s10434-013-2882-0.
Abbott DE, Tzeng C-WD, Merkow RP, Cantor SB, Chang GJ, Katz MH, Bentrem DJ, Bilimoria KY, Crane CH, Varadhachary GR, Abbruzzese JL, Wolff RA, Lee JE, Evans DB, Fleming JB. The cost-effectiveness of neoadjuvant chemoradiation is superior to a surgery-first approach in the treatment of pancreatic head adenocarcinoma. Ann Surg Oncol. 2013 Dec;20 Suppl 3:S500–S508.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

December 2013

Volume

20 Suppl 3

Start / End Page

S500 / S508

Location

United States

Related Subject Headings

  • Survival Rate
  • Radiotherapy, Adjuvant
  • Quality-Adjusted Life Years
  • Prospective Studies
  • Prognosis
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoadjuvant Therapy