Background: Esophageal cancer (EC) is a complex disease. Poor treatment results and high medical expense make it unpopular in cost-effectiveness analyses. At present, the main treatment for EC is surgical or non-surgical treatment. The aim of this study is to compare relative performance in terms of survival time and medical expenses of the 2 treatments for EC patients at different stages. This Result can be used to assist clinical decision making. Materials and
Methods: Charge & clinical data of 356 EC patients treated between 2000/1 to 2003/6 were collected. Patients were divided into 2 groups—surgical & non-surgical groups. Survival time, total expense, expense per month and relative expense performance index (REPI) for 2 treatments were calculated and compared between patients at different stages.
Results: The survival time and total expense in surgical group were longer and higher than in non-surgical treatment at all stages. Expense per month of EC patients at stage I, II & III were not significantly different between 2 groups. The expense per month in surgical group is significantly more than non-surgical group only for patients at stage IV. The REPI for patients at stage III was the highest and for patients at stage IV was lowest among four stages.
Conclusions: From the perspective of survival time and REPI, patients at early stage of EC, even stage III, surgical treatment was a better treatment than non-surgical treatment. But, for EC patients at stage IV, surgical treatment has a low REPI which suggests that surgical treatment may need further evaluation if medical expenses were included in clinical consideration.

Stage	Variable	Surgical group	Non-surgical group	p value
I	Survival time (mo)	47.4	14.7	0.002
	Total expense*	23216	9564	0.021
	Expense per month*	919	822	0.773
	REPI**	2.882
II	Survival time (mo)	37.0	23.0	0.035
	Total expense	25200	11420	<0.001
	Expense per month	2266	1332	0.243
	REPI	0.946
III	Survival time (mo)	23.0	12.9	<0.001
	Total expense	24694	11676	<0.001
	Expense per month	2373	1965	0.408
	REPI	1.476
IV	Survival time (mo)	13.8	8.6	<0.001
	Total expense	22873	12352	<0.001
	Expense per month	5000	2414	0.004
	REPI	0.775

*Total expense and expense per month were calculated within 3 years after diagnosis in USD
**REPI was calculated by the ratio of survival time benefit divided by the ratio of expense per month