Surgery Is Slightly More Cost-Effective than Radiotherapy for Esophageal Cancer in China

Why It Matters

The findings guide Chinese health‑policy makers in prioritising surgical pathways for ESCC, potentially reshaping reimbursement and treatment guidelines. Demonstrating favorable cost‑effectiveness may improve patient outcomes while containing system‑wide costs.

Key Takeaways

• Surgery improves median OS by ~11 months.
• Incremental cost per QALY ≈ $34.7k.
• Cost‑effectiveness rises to 62.5% at higher WTP.
• Adverse‑event and immunotherapy costs dominate sensitivity analysis.
• Real‑world Markov model based on 196 ESCC patients.

Pulse Analysis

Esophageal squamous cell carcinoma remains a leading cause of cancer mortality in China, accounting for the majority of esophageal cancer cases. Unlike Western markets where adenocarcinoma predominates, Chinese clinicians confront a disease profile that often presents at earlier stages but still demands aggressive multimodal therapy. As government insurance covers a substantial share of oncology spending, decision‑makers increasingly rely on health‑economic evidence to balance clinical benefit against budgetary constraints, making rigorous cost‑effectiveness studies essential.

The study leveraged a TreeAge Pro Markov framework, integrating survival curves, utility weights, and actual treatment expenditures from 196 patients treated at the Fourth Hospital of Hebei Medical University. By modeling disease progression after surgery or radiotherapy—both supplemented with peri‑treatment chemo‑immunotherapy—the analysis produced an incremental cost‑effectiveness ratio of roughly $34,745 per QALY. Probabilistic simulations showed the likelihood of surgery being cost‑effective climbing from 10% to 62.5% as willingness‑to‑pay thresholds increased, while one‑way sensitivity highlighted adverse‑event management and immunotherapy costs as the most influential parameters.

These results carry direct implications for Chinese oncology policy. A demonstrated cost‑effectiveness advantage for surgery could prompt insurers to favour surgical pathways in reimbursement formularies, encouraging hospitals to invest in surgical capacity and postoperative care. Moreover, the methodology—real‑world data feeding a transparent Markov model—offers a template for evaluating other high‑cost cancer interventions. Future research should expand to multicenter cohorts and incorporate patient‑reported outcomes to refine utility estimates, ensuring that economic assessments remain aligned with evolving clinical practice and patient preferences.