Active surveillance versus standard surgery and cost-effectiveness after neoadjuvant chemoradiotherapy for esophageal cancer

Active surveillance (AS) is noninferior to standard surgery for 2-year survival and improves short-term health-related quality of life (HRQOL) among patients with a complete clinical response (CCR) after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. Although AS reduces the upfront costs of surgery and hospital stay, it requires repeated diagnostic tests and, for some patients, delayed surgery and hospitalization during follow-up. A prespecified secondary analysis of the Surgery as Needed for oesophageal cancer (SANO) trial, at 12 hospitals in The Netherlands, assessed the cost-effectiveness of AS compared with standard surgery after nCRT. The study enrolled 309 patients with esophageal cancer who achieved a CCR after nCRT, with up to 5 years of follow-up. The AS group consisted of 198 patients and the standard surgery group consisted of 111 patients. Those in the AS group had a mean of 2.99 QALYs at 5 years, versus 2.88 QALYs in the standard surgery group. Mean health care cost at 5 years were EUR 36 733 in the AS group versus EUR 45 106 in the standard surgery group. The authors conclude that AS is a cost-effective alternative to standard surgery after nCRT for esophageal cancer and may reduce health care costs without compromising patient outcomes.