Health economic evaluation of watch and wait policy after clinical complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients

Background: Non-surgical Watch & Wait (W&W) policy has recently gained prominence in the treatment of patients with locally advanced rectal cancer with a clinical complete response after neoadjuvant chemoradiotherapy. By omitting surgery, peri and postoperative morbidity and mortality could be avoided. Objective: The aim of this study is to estimate long-term clinical value of Watch & Wait strategy in terms of quality of life, life expectancy and costs. Method: A Markov model was used with input parameters derived from demographics, literature and expert elicitation. A hypothetical population of 100,000 locally advanced rectal cancer patients was considered at the restaging phase after neoadjuvant therapy. The current golden standard of TME surgery was compared with W&W implementation, and a univariate sensitivity analysis was performed. Results: The model indicates that an implementation of Watch & Wait policy leads to an increase of Quality-Adjusted Life Years (QALYs) of 0.089 and cost savings of €511 ($583) per patient. Discussion: This study provides supportive evidence for the implementation W&W strategy. Furthermore, it shows an incentive for further research into increasing sensitivity and specificity rates for Watch & Wait inclusion.