Cost-effectiveness analysis of operative versus non-operative management of colorectal cancer metastases in the Finnish RAXO Study
Year: 2026
Type: article
Abstract: BACKGROUND AND PURPOSE: Cancer therapies place an increasing financial burden on societies. In metastatic colorectal cancer (mCRC), an optimised curative-intent treatment combines metastasectomy, local ablative therapy, and perioperative systemic anti-cancer therapy (SACT) under multidisciplinary team guidance. The resource-intensive operative treatment strategy results in better survival than a non-operative approach with SACT only. The cost-effectiveness of the strategy including operative treatment has not been investigated in the era of modern treatment options. Patient/material and methods: A Markov model was developed to estimate lifetime healthcare costs and quality-adjusted life-years (QALYs). Patients receiving operative treatment, including metastasectomy along with SACT, and those receiving non-operative treatment with SACT only, were identified from the prospective Finnish RAXO study that recruited 1,086 patients between 2012 and 2018. Cost-effectiveness analyses and sensitivity analyses were conducted from the healthcare payer's perspective using 2023 cost levels. RESULTS: The mean lifetime costs (158,309€) for patients with an operative treatment produced 6.57 life years and 5.91 QALYs according to the Markov model. The non-operative treatment group had costs of 77,182€, producing 1.99 life years and 1.74 QALYs. The incremental cost-effectiveness ratio (ICER) was 19,455€/QALY, with the caveat that more favourable characteristics were present in the operative group. In probabilistic sensitivity analyses with a willingness-to-pay threshold of 30,000€/QALY, the operative treatment group had an 81% probability of being cost-effective. The results were robust in adjusted sensitivity analyses, including propensity score matched subgroups. INTERPRETATION: An operative treatment strategy is cost-effective at a commonly referenced acceptability threshold.
Source: Acta Oncologica
Authors: Joel Kontiainen, Kaisa Lehtomäki, Timo Muhonen, Jarmo Hahl, Iiro Toppila, Tuija Poussa, Emerik Osterlund, Eetu Heervä, Hanna Stedt, Raija Kallio, Päivi Halonen, Arno Nordin, Aki Uutela, Tapio Salminen, Sonja Aho, Maarit Bärlund, Annika Ålgars, Raija Ristamäki, Annamarja Lamminmäki, Bengt Glimelius, Helena Isoniemi, Pia Osterlund
Institutions: Tampere University, Pirkanmaa Hospital District, Tampere University Hospital, University of Tampere, University of Helsinki, Helsinki University Hospital, Nokia (Finland), Uppsala University, University of Turku, Turku University Hospital, University of Eastern Finland, Kuopio University Hospital, Oulu University Hospital, University of Oulu, Karolinska University Hospital, Karolinska Institutet
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W7127296853