A cost-effectiveness modeling study of treatment interventions for stage I to III esophageal squamous cell carcinoma

Background: Esophageal cancer causes considerable costs for health systems. Appropriate treatment options for
patients with esophageal squamous cell carcinoma (ESCC) can reduce medical costs and provide more improved
outcomes for health systems and patients. This study evaluates the cost‑effectiveness of treatment interventions for
patients with ESCC according to the Iranian health system.
Material and methods: A five‑state Markov model with a 15‑year time horizon was performed to evaluate the
cost‑effectiveness of treatment interventions based on stage for ESCC patients. Costs ($US 2021) and outcomes were
calculated from the Iranian health system, with a discount rate of 3%. One‑way sensitivity analyses were performed to
assess the potential effects of uncertain variables on the model results.
Results: In stage I, the Endoscopic Mucosal Resection (EMR) treatment yielded the lowest total costs and highest
total QALY for a total of $1473 per QALY, making it the dominant strategy compared with esophagectomy and EMR
followed by ablation. In stages II and III, chemoradiotherapy (CRT) followed by surgery dominated esophagectomy.
CRT followed by surgery was also cost‑effective with an incremental cost‑effectiveness ratio (ICER) of $2172.8 per
QALY compared to CRT.
Conclusion: From the Iranian health system’s perspective, EMR was the dominant strategy versus esophagectomy
and EMR followed by ablation for ESCC patients in stage I. The CRT followed by surgery was a cost‑effective interven‑
tion compared to CRT and esophagectomy in stages II and III.