AimHealth Technology Wales sought to evaluate the clinical and cost‐effectiveness of contact X‐ray brachytherapy (CXB) for early‐stage rectal cancer.MethodsRelevant studies were identified through systematic searches of MEDLINE, Embase, Cochrane Library and Scopus. A cost‐utility model was developed to estimate the cost‐effectiveness of CXB in National Health Service Wales, using results of the Organ Preservation in Early Rectal Adenocarcinoma (OPERA) trial. Patient perspectives were obtained through the Papillon Patient Support group and All‐Wales Cancer Network.ResultsThe OPERA randomized controlled trial showed that CXB improved complete response and organ preservation rates compared with external‐beam boost for people with T2–3b, N0–1, M0 rectal cancer who are fit for surgery. Managing more of this population non‐operatively after CXB was estimated to provide 0.2 quality‐adjusted life years at an additional cost of £887 per person. CXB was cost effective compared with external‐beam boost at a cost of £4463 per quality‐adjusted life year gained. This conclusion did not change in scenario analysis and CXB was cost effective in 91% of probabilistic sensitivity analyses. Patients valued receiving clear information on all available options to support their individual treatment choices. The detrimental impact of a stoma on quality of life led some patients to reject the idea that surgery was their only option.ConclusionThis evidence review and cost‐utility analysis indicates that CXB is likely to be clinically and cost effective, as part of a watch and wait strategy for adults fit for surgery. Wider access to CXB is supported by patient testimonies.

中文翻译：

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低能量接触式 X 射线近距离治疗治疗直肠癌：威尔士卫生技术局的卫生技术评估

AimHealth Technology Wales 试图评估接触式 X 射线近距离放射治疗 (CXB) 治疗早期直肠癌的临床和成本效益。方法通过系统检索 MEDLINE、Embase、Cochrane Library 和 Scopus 来确定相关研究。使用早期直肠腺癌器官保存 (OPERA) 试验的结果，开发了成本效用模型来评估 CXB 在威尔士国家卫生服务中的成本效益。通过 Papillon 患者支持小组和全威尔士癌症网络获得了患者的观点。结果 OPERA 随机对照试验表明，对于 T2-3b、N0-1、M0 患者，与外照射增强相比，CXB 提高了完全缓解率和器官保存率适合手术的直肠癌。据估计，在 CXB 后对更多的此类人群进行非手术治疗可提供 0.2 个质量调整生命年，但每人的额外费用为 887 英镑。与外部光束增强相比，CXB 具有成本效益，每个质量调整生命年的成本为 4463 英镑。这一结论在情景分析中没有改变，并且 CXB 在 91% 的概率敏感性分析中具有成本效益。患者重视获得有关所有可用选项的明确信息，以支持他们的个人治疗选择。造口对生活质量的不利影响导致一些患者拒绝接受手术是他们唯一选择的想法。结论这项证据审查和成本效用分析表明，CXB 可能具有临床效果和成本效益，作为观察和治疗的一部分。适合手术的成年人的等待策略。患者证词支持更广泛地使用 CXB。