An economic analysis of contemporary oesophagogastric cancer care in a regional UK cancer network and analysis of factors relating to postoperative outcomes

Wheat, Jennifer 2020. An economic analysis of contemporary oesophagogastric cancer care in a regional UK cancer network and analysis of factors relating to postoperative outcomes. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

This thesis explores the cost-effectiveness of the full spectrum of management options for oesophagogastric cancer, according to stage of disease. There has been a paradigm shift in decision-making regarding oesophagogastric cancer towards greater consideration of quality of life outcomes and a financially-driven interest in the cost-effectiveness of treatment in the NHS. The triad of cost per treatment option, analysis of stage-for-stage, treatment-by-treatment survival and an in-depth review of health-related quality of life as an outcome of oesophageal and gastric cancer treatment allows cost-utility analysis to be performed. This generates a cost per quality adjusted life year (QALY) according to stage, for contemporaneous oesophagogastric cancer care in a UK setting. These studies provide evidence that treating early stage disease is vastly more cost effective than treating advanced disease, and some treatment pathways for advanced disease exceed the cost per QALY gained ‘willingness to pay’ thresholds used by the National Institute of Health and Care Excellence (NICE). The accuracy and value of quality assurance metrics are explored using surgeon-level, department-level, and unit-level mortality data from one UK region. Morbidity rates as a quality assurance tool are explored as an alternative, or adjunctive consideration in the assessment of surgeon performance. The study found that annual quality assurance metrics demonstrate the most variation, and 3-year metrics may be more representative. Quality indicators such as lymph node harvest, circumferential resection margin (CRM) positivity, serious post-operative complications such as anastomotic leak rates add granularity to the assessment of surgeon performance. Periodically, new technologies revolutionise the investigation or management of disease. The routine use of positron emission 6 tomography- computerised tomography (PET-CT) in the staging of oesophageal cancer shows independently significant improvements in overall and disease-free survival, and significantly fewer patients develop recurrence, with a particular reduction in distal recurrence.

Item Type:	Thesis (MD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Date of First Compliant Deposit:	28 March 2022
Last Modified:	19 Apr 2023 08:28
URI:	https://orca.cardiff.ac.uk/id/eprint/148919

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