Cost Effectiveness of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Management of Colorectal Peritoneal Carcinomatosis

• Published in: Annals of surgical oncology Vol. 25; no. 8; pp. 2340 - 2346
• Main Authors: Lee, Z. J., Chia, S. L., Tan, G., Soo, K. C., Teo, C. C. M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2018; Springer Nature B.V
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Chemotherapy, Cancer, Regional Perfusion - economics; Colorectal Cancer; Colorectal carcinoma; Colorectal Neoplasms - economics; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Combined Modality Therapy; Cost-Benefit Analysis; Cytoreduction Surgical Procedures - economics; Disease Management; Female; Follow-Up Studies; Gastric cancer; Humans; Hyperthermia, Induced - economics; Male; Medicine; Medicine & Public Health; Metastases; Middle Aged; Morbidity; Neoplasm Recurrence, Local - economics; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Oncology; Patients; Peritoneal Neoplasms - economics; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - therapy; Peritoneum; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival; Survival Rate; Hyperthermic Intraperitoneal Chemotherapy (HIPEC); Palliative Chemotherapy; Colorectal Peritoneal Carcinomatosis; Cytoreductive Surgery; National Cancer Centre Singapore (NCCS)
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6508-4

Background Peritoneal carcinomatosis from colorectal cancer is a stage 4 disease for which palliative chemotherapy has traditionally been considered the mainstay of treatment. Since the development of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by Sugarbaker, this combined method treatment has resulted in improved survival outcomes with acceptable morbidity for selected patients with peritoneal carcinomatosis. This study examined the cost effectiveness of CRS and HIPEC compared with palliative chemotherapy for patients with peritoneal carcinomatosis from colorectal cancer within the context of the Singaporean health care system. Methods A retrospective review of patients with peritoneal carcinomatosis from histologically proven colorectal cancer treated at the National Cancer Centre Singapore (NCCS) was conducted. Results The average cost of CRS and HIPEC per patient was S$83,680.26, and the median overall survival period was 47 months. The calculated cost per life year attained for a patient who underwent CRS and HIPEC was S$21,365.19 per life year. In comparison, the average cost of palliative chemotherapy was S$44,478.87, with a median overall survival of 9 months, and the calculated cost per life year attained for a patient in this treatment group was S$59,305.16 per life year. Conclusion The findings show that CRS and HIPEC results in prolonged survival for selected patients with colorectal peritoneal carcinomatosis and a lower cost per life year attained than for the traditionally used palliative chemotherapy. It should logically be the preferred treatment of choice for selected patients with colorectal peritoneal metastasis.