A1 Refereed original research article in a scientific journal
Cost-effectiveness analysis of operative versus non-operative management of colorectal cancer metastases in the Finnish RAXO Study
Authors: Kontiainen, Joel; Lehtomäki, Kaisa; Muhonen, Timo; Hahl, Jarmo; Toppila, Iiro; Poussa, Tuija; Osterlund, Emerik; Heervä, Eetu; Stedt, Hanna; Kallio, Raija; Halonen, Päivi; Nordin, Arno; Uutela, Aki; Salminen, Tapio; Aho, Sonja; Bärlund, Maarit; Ålgars, Annika; Ristamäki, Raija; Lamminmäki, Annamarja; Glimelius, Bengt; Isoniemi, Helena; Osterlund, Pia
Publisher: Medical Journals Sweden
Publication year: 2026
Journal: Acta Oncologica
Volume: 65
First page : 36
Last page: 45
ISSN: 0284-186X
eISSN: 1651-226X
DOI: https://doi.org/10.2340/1651-226X.2026.45005
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Open Access publication channel
Web address : https://doi.org/10.2340/1651-226x.2026.45005
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/515609469
Self-archived copy's licence: CC BY
Self-archived copy's version: Publisher`s PDF
Background and purpose
Cancer therapies place an increasing financial burden on societies. In metastatic colorectal cancer (mCRC), an optimised curative-intent treatment combines metastasectomy, local ablative therapy, and perioperative systemic anti-cancer therapy (SACT) under multidisciplinary team guidance. The resource-intensive operative treatment strategy results in better survival than a non-operative approach with SACT only. The cost-effectiveness of the strategy including operative treatment has not been investigated in the era of modern treatment options.
Patient/material and methods
A Markov model was developed to estimate lifetime healthcare costs and quality-adjusted life-years (QALYs). Patients receiving operative treatment, including metastasectomy along with SACT, and those receiving non-operative treatment with SACT only, were identified from the prospective Finnish RAXO study that recruited 1,086 patients between 2012 and 2018. Cost-effectiveness analyses and sensitivity analyses were conducted from the healthcare payer’s perspective using 2023 cost levels.
Results
The mean lifetime costs (158,309€) for patients with an operative treatment produced 6.57 life years and 5.91 QALYs according to the Markov model. The non-operative treatment group had costs of 77,182€, producing 1.99 life years and 1.74 QALYs. The incremental cost-effectiveness ratio (ICER) was 19,455€/QALY, with the caveat that more favourable characteristics were present in the operative group. In probabilistic sensitivity analyses with a willingness-to-pay threshold of 30,000€/QALY, the operative treatment group had an 81% probability of being cost-effective. The results were robust in adjusted sensitivity analyses, including propensity score matched subgroups.
Interpretation
An operative treatment strategy is cost-effective at a commonly referenced acceptability threshold.
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Funding information in the publication:
This investigator-initiated study was supported by Finska Läkaresällskapet (2016, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025), The Finnish Cancer Foundation (2019–2020, 2021, 2022–2023, 2025), Relander’s Foundation (2020–2022), The Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki, Turku, Kuopio, Oulu, and Satakunta Hospitals (2012, 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025), Tampere University Hospital Fund (Tukisäätiö 2019, 2020, 2023, 2024 and OOO-project 2020, 2022), Helsinki University Hospital research fund (2019, 2020, 2021, 2022, 2023, 2024), Mary and Georg C. Ehrnrooth Foundation (2023), Liv & Hälsa (2023), Radiumhemmets fonder (2022–2023, 2025–2026), Cancerfonden (2023–2024); and the infrastructure with the database and study nurses was partly supported by pharmaceutical companies: Amgen – unrestricted grant (2012–2024), Eli Lilly and Company (2012–2017), Merck KGaA (2012–2020), Roche Oy (2012–2020), Sanofi (2012–2017), and Servier – unrestricted grant (2016–2025). J.K. received personal grants from The Finnish Medical Foundation and Juhani Aho Foundation for Medical Research. The funders had no role in the study design, analysis, interpretation of the data or decision to publish.
