Polsky Daniel, Mandelblatt Jeanne S, Weeks Jane C, Venditti Laura, Hwang Yi-Ting, Glick Henry A, Hadley Jack, Schulman Kevin A
University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
J Clin Oncol. 2003 Mar 15;21(6):1139-46. doi: 10.1200/JCO.2003.03.126.
To use 5 years of primary data to compare the incremental cost-effectiveness of breast conservation and radiation versus mastectomy with the restriction of choice to a single therapy versus providing a choice of either therapy.
We evaluated a random retrospective cohort of 2,517 Medicare beneficiaries treated for newly diagnosed stage I or II breast cancer from 1992 through 1994. The outcome measures were quality-adjusted life-years (QALYs) and 5-year medical costs. Risk and propensity score adjustments were used in the analysis.
A breast conservation and radiation regimen has significantly higher costs than mastectomy in the first year after surgery; the adjusted 5-year costs are $14,054 (95% confidence interval, $9,791 to $18,312) greater than those of mastectomy. The adjusted incremental cost-effectiveness ratio comparing breast conservation and radiation to mastectomy was $219,594 per QALY for the comparison of the two strategies. If the possibility of patient choice from maintaining the availability of multiple treatments versus restricting choice to mastectomy alone provides a quality-of-life gain of 0.031 QALYs, then the cost-effectiveness ratio of this choice option is $80,440 per QALY.
The current system of providing a choice between mastectomy and breast conservation surgery is economically attractive when the economic analysis includes the benefit of patient choice of treatment.
利用5年的原始数据，比较保乳加放疗与乳房切除术的增量成本效益，比较的情况为将选择限制在单一治疗方案与提供两种治疗方案供选择。
我们评估了1992年至1994年期间接受新诊断的I期或II期乳腺癌治疗的2517名医疗保险受益人的随机回顾性队列。结果指标为质量调整生命年（QALY）和5年医疗费用。分析中使用了风险和倾向评分调整。
保乳加放疗方案在术后第一年的成本显著高于乳房切除术；调整后的5年成本比乳房切除术高14,054美元（95%置信区间，9,791美元至18,312美元）。比较保乳加放疗与乳房切除术的调整后的增量成本效益比为每QALY 219,594美元。如果患者从维持多种治疗方案的可用性与仅限制为乳房切除术的选择中获得的生活质量提高为0.031 QALY，那么这种选择方案的成本效益比为每QALY 80,440美元。
当经济分析包括患者选择治疗的益处时，目前在乳房切除术和保乳手术之间提供选择的系统在经济上具有吸引力。
