Lee Jason H, Glick Henry A, Hayman James A, Solin Lawrence J
Department of Radiation Oncology, Division of General Internal Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
J Clin Oncol. 2002 Jun 1;20(11):2713-25. doi: 10.1200/JCO.2002.07.008.
To present a decision model that describes the clinical and economic outcomes of node-positive breast cancer with and without postmastectomy radiation therapy (PMRT).
A Markov process was constructed to project the natural history of breast cancer following mastectomy in premenopausal node-positive women. Biannual hazards of local and distant recurrence without PMRT were derived from a large meta-analysis of adjuvant systemic therapy trials for breast cancer. The addition of PMRT reduced the risk of disease relapse by an odds ratio of 0.69. Costs of PMRT ($11,600) and recurrent breast cancer ($4,250 to 16,200/year) were estimated from available literature. The model projected number of recurrences, relapse-free and overall survival, and costs to 15 years, using a discount rate of 3%. Cost-effectiveness ratios were calculated per incremental year of life and quality-adjusted year of life gained. One- and two-way sensitivity analyses were performed to determine the sensitivity of results to clinical and economic assumptions.
The model projected 15-year relapse-free survival of 52% and 43% with and without PMRT, respectively. Overall survival was increased from 48% to 55% with PMRT, resulting in an incremental 0.29 years of life gained per subject. PMRT increased 15-year costs from $40,800 to $48,100. Cost per year of life gained was $24,900, or $22,600 when survival was adjusted for quality of life. Results of the model were relatively sensitive to radiation therapy cost and breast cancer relapse risk.
This analysis suggests that PMRT offers substantial clinical benefits achieved in a cost-effective manner, with an average cost per year of life gained of $24,900. Results of the model were robust under a wide range of clinical and economic parameters.
提出一个决策模型，该模型描述了接受和未接受乳房切除术后放射治疗（PMRT）的淋巴结阳性乳腺癌的临床和经济结局。
构建一个马尔可夫过程，以预测绝经前淋巴结阳性女性乳房切除术后乳腺癌的自然病程。未接受PMRT时局部和远处复发的半年风险来自对乳腺癌辅助全身治疗试验的大型荟萃分析。添加PMRT可使疾病复发风险降低，优势比为0.69。PMRT的成本（11,600美元）和复发性乳腺癌的成本（每年4,250至16,200美元）根据现有文献估算。该模型预测了复发次数、无复发生存期和总生存期以及15年的成本，贴现率为3%。计算每增加一年生命和获得的质量调整生命年的成本效益比。进行单向和双向敏感性分析，以确定结果对临床和经济假设的敏感性。
该模型预测，接受和未接受PMRT的患者15年无复发生存率分别为52%和43%。接受PMRT后，总生存期从48%提高到55%，每位受试者的生命增量为0.29年。PMRT使15年成本从40,800美元增加到48,100美元。每获得一年生命的成本为24,900美元，调整生存质量后的成本为22,600美元。该模型的结果对放射治疗成本和乳腺癌复发风险相对敏感。
该分析表明，PMRT以具有成本效益的方式提供了显著的临床益处，每获得一年生命的平均成本为24,900美元。在广泛的临床和经济参数范围内，该模型的结果是稳健的。
