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. 2025 Jan;32(1):137-157.
doi: 10.1245/s10434-024-16056-4. Epub 2024 Aug 24.

Economic Evaluation of 'Watch and Wait' Following Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review

Ishraq Murshed  1   2 , Zachary Bunjo  3 , Warren Seow  3 , Ishmam Murshed  3 , Sergei Bedrikovetski  4 , Michelle Thomas  3   4 , Tarik Sammour  3   4
Affiliations

Economic Evaluation of 'Watch and Wait' Following Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review

Ishraq Murshed et al. Ann Surg Oncol. 2025 Jan.

Abstract

Background: Owing to multimodal treatment and complex surgery, locally advanced rectal cancer (LARC) exerts a large healthcare burden. Watch and wait (W&W) may be cost saving by removing the need for surgery and inpatient care. This systematic review seeks to identify the economic impact of W&W, compared with standard care, in patients achieving a complete clinical response (cCR) following neoadjuvant therapy for LARC.

Methods: The PubMed, OVID Medline, OVID Embase, and Cochrane CENTRAL databases were systematically searched from inception to 26 April 2024. All economic evaluations (EEs) that compared W&W with standard care were included. Reporting and methodological quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), BMJ and Philips checklists. Narrative synthesis was performed. Primary and secondary outcomes were (incremental) cost-effectiveness ratios and the net financial cost.

Results: Of 1548 studies identified, 27 were assessed for full-text eligibility and 12 studies from eight countries (2016-2024) were included. Seven cost-effectiveness analyses (complete EEs) and five cost analyses (partial EEs) utilized model-based (n = 7) or trial-based (n = 5) analytics with significant variations in methodological design and reporting quality. W&W showed consistent cost effectiveness (n = 7) and cost saving (n = 12) compared with surgery from third-party payer and patient perspectives. Critical parameters identified by uncertainty analysis were rates of local and distant recurrence in W&W, salvage surgery, perioperative mortality and utilities assigned to W&W and surgery.

Conclusion: Despite heterogenous methodological design and reporting quality, W&W is likely to be cost effective and cost saving compared with standard care following cCR in LARC. Clinical Trials Registration PROSPERO CRD42024513874.

Keywords: Complete clinical response; Economic evaluation; Locally advanced rectal cancer; Neoadjuvant therapy; Watch & wait.

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Conflict of interest statement

Disclosure: Ishraq Murshed, Zachary Bunjo, Warren Seow, Ishmam Murshed, Sergei Bedrikovetski, Michelle Thomas, and Tarik Sammour have declared no conflicts of interest that may be relevant to the contents of this study.

Figures

Fig. 1
Fig. 1
PRISMA diagram. PRISMA preferred reporting items for systematic reviews and meta-analyses
Fig. 2
Fig. 2
Number of studies reporting CHEERS items (green, yes; red, no; grey; NA). CHEERS consolidated health economic evaluation reporting standards consolidated health economic evaluation reporting standards, NA not available
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 Countries. CA: Cancer J Clin. 2021;71(3):209–49. 10.3322/caac.21660. - DOI - PubMed
    1. Langenfeld SJ, Davis BR, Vogel JD, et al. The American society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer 2023 supplement. Dis Colon Rectum. 2024;67(1):18–31. 10.1097/dcr.0000000000003057. - DOI - PubMed
    1. Habr-Gama A, Perez RO, Wynn G, Marks J, Kessler H, Gama-Rodrigues J. Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for standardization. Dis Colon Rectum. 2010;53(12):1692–8. 10.1007/DCR.0b013e3181f42b89. - DOI - PubMed
    1. Chen TY-T, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer. 2015;14(2):106–14. 10.1016/j.clcc.2014.12.007. - DOI - PubMed
    1. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251(5):807–18. 10.1097/SLA.0b013e3181dae4ed. - DOI - PubMed

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