To relieve dysphagia is the main goal in palliative treatment of patients with incurable cancer of the oesophagus or the gastroesophageal junction.
Dr Urs Wenger conducted a prospective, randomized multicentre study.
The research team compared stent placement and brachytherapy regarding health economy and clinical outcomes.
The team included 60 patients with incurable cancer of the esophagus or gastroesophageal junction.
The patients were randomized to receive a self-expandable metallic stent or 3x7 Gy brachytherapy.
At clinical follow-up visits, the researchers scored dysphagia and recorded health care consumptions.
|Brachytherapy charges had to be reduced by 31% to make it cost-competitive|
|European Journal of Gastroenterology & Hepatology|
Costs were based on hospital debits.
The team calculated total lifetime healthcare consumption costs and costs for the initial treatments and conducted a sensitivity analysis.
The researchers found no difference in survival or complication rates between the 2 treatment strategies.
There was a significant difference in the change of dysphagia scores between the time of inclusion and the 1-month follow-up visit, in favour of the stented group.
The research team noted that this difference had disappeared at 3 months.
Median total lifetime costs were €17,690 for the stented group compared with €33,171 for the brachytherapy group.
The team observed that this difference was due to higher costs for the initial treatment.
Sensitivity analyses showed that the charges for a brachytherapy session had to be reduced by 31% to make this therapeutic concept cost-competitive.
Dr Wenger's team concluded, “Stenting is currently more cost-effective compared with fractionated 3x7 Gy brachytherapy for patients with incurable cancer of the esophagus and gastroesophageal junction.”