Intraoperative electron-beam radiotherapy in locally advanced rectal cancer, in patients submitted to suboptimal surgery: economic analysis on the Brazilian Private Health Care system perspective

Abstract

Objective: This study aimed to evaluate the cost-effectiveness of intraoperative electron radiotherapy (IOeRT) in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant radio- -chemotherapy, followed by incomplete resection (compromised margin or gross residual disease). Methods: A Markov model was constructed. Data on efficacy, side effects, local control and overall survival were extracted from the literature. The perspective was that of the Brazilian private health system. For the cost and effectiveness, an annual discount rate of 5% was considered. Results: The strategy that contained IOeRT was, in this scenario, dominant, in comparison to standard of care. Results were considered robust, after univariate and multivariate sensitivity analyzes. Conclusions: We concluded that it can be advantageous, both for patients with LARC submitted to suboptimal surgery, as well as for Brazilian health insurance companies, the application of IOeRT. Although it is suggested that these results should be confirmed later, through the collection of real-world data, due to the absence of randomized controlled trials, in this specific clinical scenario.