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

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

Clinical outcomes showed a mortality benefit in the regionalized arm versus the local arm, creating economic dominance where costs are cheaper in the same arm with better clinical benefit

Sensitivity analysis of over 10,000 scenarios showed nearly all scenarios clustered in quadrant 4, where regionalization is the dominant strategy with both lower costs and better effectiveness than local care

Cost-effectiveness methodologies are particularly helpful for population level decision making, averaging expectations and outcomes across all patients rather than individual patient selection

Regionalized rectal cancer surgery is the dominant cost-effective strategy compared to local rectal cancer surgery

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

Cost-effectiveness analysis is based on assumptions that can sway results dramatically

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

High-volume centers using robotics will increase the cost per case significantly

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

Healthcare is moving toward de-regionalization with home monitoring, telementoring, and bringing healthcare to the patient rather than patient to centers

In some healthcare systems, a community oncologist an hour and a half away presents every single rectal cancer case to an entire board across the entire system

The data is not good enough yet to support a regionalized decentralized model using technology to export expertise