Best of the Best Gen Surg - How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery - Dr. Leeds

Regionalization of rectal cancer surgery increases lymph node yield.

Regionalization of rectal cancer surgery increases the use of neoadjuvant therapy.

Regionalization of rectal cancer surgery decreases 30 and 90-day mortality.

Regionalization of rectal cancer surgery is associated with a 34% decrease in 5-year mortality.

More than 3 times the number of patients would have to travel more than 50 miles to achieve regionalized care compared to local care.

Patients who travel for regionalized rectal cancer surgery tend to be more white and more privately insured, raising issues of healthcare equity.

The marginal cost per patient in the decision tree model was cheaper with regionalized care compared to local care.

The decision tree model showed a mortality benefit in the regionalized arm versus the local arm.

Regionalized rectal cancer surgery demonstrates economic dominance, with both lower costs and better clinical benefit than local care.

In sensitivity analysis of over 10,000 scenarios, nearly all scenarios showed regionalization as the dominant strategy with lower costs and better effectiveness than local care.

Cost-effectiveness methodologies are particularly helpful for population level decision making but less helpful for individual patient selection.

Local rectal cancer surgery is rarely cost-effective in this model under even the most extreme sensitivity scenarios.

The model ran through 10,000 iterations with very wide confidence bars around each estimate to test robustness.

In 97.8% of the model scenarios, regionalized care won out over local care when including downstream costs of cancer recurrence and early death.

Regionalized care per case is more expensive than local care when looking only at case costs.

In some healthcare systems, a community oncologist presents every single one of their rectal cancer cases to an entire board across the entire system.

The data is not yet good enough to support a regionalized decentralized model for rectal cancer care.