Clinical Practice Guidelines - National Health and Medical Research ...

22.9.3 Other
A small number of studies have investigated other treatment alternatives such as preoperative
radiotherapy and radiofrequency ablation.
In the Netherlands, van den Brink et al 124 evaluated the cost utility of preoperative radiotherapy (PRT)
and found that, in the short term, PRT is effective and cost-effective, with a cost/QALY gained of
$US25,100 ($A40,015). Sensitivity analysis confirmed the results are robust. In a Swedish study,
Dahlberg et al 125 investigated the cost-effectiveness of PRT in the primary treatment of resectable
rectal cancer and found it to be cost-effective with a cost/LYG of $US3654 ($A6134). Even in the
most pessimistic scenario, the cost/LYG was US15,228 ($A25,562). These studies provide some
evidence that PRT is cost-effective, but additional evidence from further research is needed before a
definitive recommendation can be made.
Radiofrequency (RF) ablation for the treatment of liver metastases was evaluated in a costeffectiveness
study by Shetty et al. 126 Results of the study indicate RF ablation is a cost-effective
strategy compared to palliative care. Incremental cost-effectiveness ratios per life year gained at six
months, one-, two-, three- and five-year median survival were $US20,424, $US11,407, $US6731,
$US5034 and $US3492 ($A31,895, $A17,814, $A10,512, $A7861 and $A5453). Sensitivity analysis
shows that the results, though sensitive to observation hours, number of lifetime treatments, frequency
of follow up, and cost of abdominal CT and outpatient treatment, remain cost-effective. While these
results suggest that RF is cost-effective, recommendations cannot be based on the findings of only one
study. These results indicate that RF is potentially cost-effective with further research required.
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The prevention, early detection and management of colorectal cancer