A cost comparison of photodynamic therapy and metallic stents in the palliation of oesophageal cancer

SummaryBackgroundThere is currently little information on the cost effectiveness of photodynamic laser therapy (PDT) compared with other palliative treatments for oesophageal cancer.AimTo compare the cost of oesophageal cancer palliation associated with PDT with those of another standard option, self-expanding metallic stents.MethodsA cost comparison study using prospectively and retrospectively collected data was conducted. Data was collected from 25 patients who had received PDT between 1999 and 2003. Costs were compared with data from patients who received a metallic stent between 1998 and 2000. Costs were estimated using routine costs for the year 2002–2003.ResultsPatients receiving PDT or oesophageal stents were similar in terms of age, gender and tumour presentation. Patients receiving PDT had slightly shorter duration of symptoms, less metastatic spread but similar dysphagia scores to those in the oesophageal stent group. Costs of initial PDT treatment were significantly higher than those associated with stent placement (PDT mean costs £2068.48 versus stent mean costs £1086.76; cost difference £981.72 (95% CI: £844.47–1118.96)). This higher cost persisted throughout future re-interventions and hospital episodes. Patients receiving PDT survived longer however (132.5 (70.5–250 days) (medium IQR)) than those receiving a stent 105 (31–172.5 days), thus the mean cost per day's survival was equivalent between the two treatments. There was no impact of PDT on patients’ quality of life at 6 weeks post-treatment.ConclusionsAlthough initially more expensive than metallic stents, a longer survival results in PDT being as cost effective as stenting in oesophageal palliation. A larger, randomised controlled trial is required combining both economic evaluation and quality of life measurement to fully establish the best palliative treatment in this disease.