Total neoadjuvant therapy (TNT) is an evolving treatment schedule for locally advanced rectal cancer (LARC), allowing for organ preservation in a relevant number of patients in the case of complete response. Patients who undergo this so-called “watch and wait” approach are likely to benefit regarding their quality of life (QoL), especially if definitive ostomy could be avoided. In this work, we performed the first cost-effectiveness analysis from the patient perspective to compare costs for TNT with radical resection after neoadjuvant chemoradiation (CRT) in the German health care system. Individual costs for patients insured with a statutory health insurance were calculated with a Markov microsimulation. A subgroup analysis from the prospective “FinTox” trial was used to calibrate the model’s parameters. We found that TNT was less expensive (−1540 EUR) and simultaneously resulted in a better QoL (+0.64 QALYs) during treatment and 5-year follow-up. The average cost for patients under TNT was 4711 EUR per year, which was equivalent to 3.2% of the net household income. CRT followed by resection resulted in higher overall costs for ostomy care, medication and greater loss of earnings. Overall, TNT appeared to be more efficacious and cost-effective from a patient’s point of view in the German health care system.
全疗程新辅助治疗（TNT）是局部进展期直肠癌（LARC）的一种新兴治疗方案，可使相当比例达到完全缓解的患者实现器官保留。接受这种"观察等待"策略的患者可能在生活质量（QoL）方面获益，特别是在能够避免永久性造口的情况下。本研究首次从患者视角开展成本效益分析，比较德国医疗体系中TNT方案与新辅助放化疗（CRT）后根治性切除术的经济负担。通过马尔可夫微观模拟模型，我们计算了法定医疗保险参保患者的个人医疗支出，并采用前瞻性"FinTox"试验的亚组数据校准模型参数。研究发现，在治疗期间及5年随访期内，TNT方案不仅更经济（节省1540欧元），同时能提升生活质量（增加0.64质量调整生命年）。TNT患者年均医疗支出为4711欧元，相当于家庭净收入的3.2%。而CRT联合切除术因造口护理、药物治疗及收入损失等因素导致总成本更高。总体而言，在德国医疗体系下，从患者视角评估TNT方案显示出更优的疗效与成本效益。
肿瘤(癌症)患者之家