Cost-effectiveness analysis of operative versus non-operative management of colorectal cancer metastases in the Finnish RAXO Study

Authors

  • Joel Kontiainen Department of Oncology, TAYS Cancer Centre, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland https://orcid.org/0009-0003-2658-2299
  • Kaisa Lehtomäki Department of Oncology, TAYS Cancer Centre, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland https://orcid.org/0000-0002-2994-1459
  • Timo Muhonen Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland https://orcid.org/0000-0003-3426-1607
  • Jarmo Hahl Medaffcon Ltd, Espoo, Finland
  • Iiro Toppila Medaffcon Ltd, Espoo, Finland
  • Tuija Poussa StatConsulting, Nokia, Finland
  • Emerik Osterlund Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0003-0973-6332
  • Eetu Heervä Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland https://orcid.org/0000-0002-6134-1170
  • Hanna Stedt Department of Oncology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland https://orcid.org/0009-0008-0105-2060
  • Raija Kallio Department of Oncology, Oulu University Hospital and University of Oulu, Oulu, Finland https://orcid.org/0000-0002-5912-496X
  • Päivi Halonen Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland https://orcid.org/0000-0002-9760-0840
  • Arno Nordin Transplantation and Liver Surgery Unit, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland https://orcid.org/0000-0002-5446-0972
  • Aki Uutela Transplantation and Liver Surgery Unit, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland https://orcid.org/0000-0003-1324-5894
  • Tapio Salminen Department of Oncology, TAYS Cancer Centre, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland https://orcid.org/0000-0003-4116-2260
  • Sonja Aho Department of Oncology, TAYS Cancer Centre, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland https://orcid.org/0000-0002-4965-5580
  • Maarit Bärlund Department of Oncology, TAYS Cancer Centre, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland https://orcid.org/0000-0002-1469-5654
  • Annika Ålgars Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland https://orcid.org/0000-0002-9841-1881
  • Raija Ristamäki Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland https://orcid.org/0000-0001-6817-3045
  • Annamarja Lamminmäki Department of Oncology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland https://orcid.org/0000-0001-7664-4468
  • Bengt Glimelius Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0002-5440-791X
  • Helena Isoniemi Transplantation and Liver Surgery Unit, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland https://orcid.org/0000-0001-6184-3405
  • Pia Osterlund Department of Oncology, TAYS Cancer Centre, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-7124-3515

DOI:

https://doi.org/10.2340/1651-226X.2026.45005

Keywords:

Cost-effectiveness, Colorectal cancer, Distant metastases, Health-related Quality of Life, health care costs

Abstract

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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2026-02-03

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Kontiainen, J., Lehtomäki, K., Muhonen, T., Hahl, J., Toppila, I., Poussa, T., … Osterlund, P. (2026). Cost-effectiveness analysis of operative versus non-operative management of colorectal cancer metastases in the Finnish RAXO Study. Acta Oncologica, 65, 36–45. https://doi.org/10.2340/1651-226X.2026.45005

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Vol. 65 (2026): Acta Oncologica

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Copyright (c) 2026 Joel Kontiainen, Kaisa Lehtomäki, Timo Muhonen, Jarmo Hahl, Iiro Toppila, Tuija Poussa, Emerik Osterlund, Eetu Heervä, Hanna Stedt, Raija Kallio, Päivi Halonen, Arno Nordin, Aki Uutela, Tapio Salminen, Sonja Aho, Maarit Bärlund, Annika Ålgars, Raija Ristamäki, Annamarja Lamminmäki, Bengt Glimelius, Helena Isoniemi, Pia Osterlund

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