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Background  Neoadjuvant concurrent chemoradiotherapy ( NCCRT ) is often considered for locally‐advanced esophageal squamous cell carcinoma ( LA ‐ ESCC ) patients; however, no data regarding the cost‐effectiveness of this treatment is available. Our study aimed to evaluate the cost‐effectiveness of  NCCRT  versus esophagectomy for  LA ‐ ESCC  at population level.    Methods  We identified  LA ‐ ESCC  patients diagnosed within 2008–2009 and treated with either  NCCRT  or esophagectomy through the  T aiwan  C ancer  R egistry. We included potential confounding covariables (age, gender, residency, comorbidity, social‐economic status, disease stage, treating hospital level and surgeon's experience, and the use of endoscopic ultrasound before treatment) and used propensity score ( PS ) to construct a 1:1 population. The duration of interest was three years within the date of diagnosis. Effectiveness was measured as overall survival. We took the payer's perspective and converted the cost to 2014 United States dollars ( USD ). In sensitivity analysis, we evaluated the potential impact of an unmeasured confounder on the statistical significance of incremental net benefit at suggested willingness‐to‐pay.    Results  Our study population constituted 150  PS  matched subjects. The mean cost (2014  USD ) and survival (year) were higher for  NCCRT  compared with esophagectomy (US$91,460 vs. $75,836 for cost; 2.2 vs. 1.8 for survival) with an estimated incremental cost‐effectiveness ratio of US$39,060/life‐year.    Conclusions  When compared to esophagectomy,  NCCRT  is likely to improve survival and is probably more cost‐effective. Cost‐effectiveness results should be interpreted with caution given our results were sensitive to potential unmeasured confounder(s) in sensitivity analysis.

thoracic cancer

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study