Manusirivithaya Sumonmal, Sripramote Manit, Tangjitgamol Siriwan, Sanjareonsuttikul Nopawan, Pisarnturakit Pagaporn
Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok 10330, Thailand.
J Med Assoc Thai. 2005 Aug;88(8):1035-44.
Concurrent chemoradiation has been advocated to be more effective than radiation alone in the treatment of cervical cancer. However, it certainly has more side effects. Hence, it is worthwhile to investigate the cost-effectiveness (CE) of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer.
The treatment of cervical cancer was modeled using the decision tree where the treatment option would be either concurrent chemoradiation or radiation alone. Patients receiving each treatment had different risks of tumor recurrence. Costs in this analysis were separated into four major categories: costs for treatment of cervical cancer, costs for treatment of major side effects, costs for follow up cancer patients, and costs for diagnosis including supportive care of recurrent cervical cancer Charges were used for the costs of chemotherapy, radiotherapy, drugs, and accessories. Unit cost was used for the costs of laboratory investigations, in-patient and out-patient services. Costs incurred after the first year were discounted at an annual rate of 5%. The benefit was measured as months of life survived. The present study evaluated the patients to 5 years after complete treatment.
The CE ratio in the concurrent chemoradiation group was 2,855 and 1,835 Baht/month survived if the chemotherapy was given as in-patient and out-patient respectively. The CE ratio in the radiation group equaled 2,366 Baht/month survived. For the sensitivity analysis, in the situation that chemoradiation was not much better than radiation alone in terms that the recurrent rate from chemoradiation group was not more than 20% lower than the radiation group, radiation therapy alone would be more cost effective even if chemotherapy was given as an out-patient basis.
Radiation alone was more cost effective than chemoradiation in the treatment of cervical cancer. Nevertheless, if chemotherapy was administered on an out-patient basis, chemoradiation will be more cost effective only if the recurrent rate from the chemoradiation group was more than 20% lower than the radiation group.
在宫颈癌治疗中，同步放化疗被认为比单纯放疗更有效。然而，它肯定有更多的副作用。因此，研究同步放化疗与单纯放疗相比在局部晚期宫颈癌治疗中的成本效益是值得的。
使用决策树对宫颈癌治疗进行建模，治疗方案为同步放化疗或单纯放疗。接受每种治疗的患者有不同的肿瘤复发风险。本分析中的成本分为四大类：宫颈癌治疗成本、主要副作用治疗成本、癌症患者随访成本以及包括复发性宫颈癌支持治疗在内的诊断成本。化疗、放疗、药物和配件的成本使用收费标准。实验室检查、住院和门诊服务的成本使用单位成本。第一年之后产生的成本按5%的年利率进行贴现。效益以存活月数衡量。本研究对患者进行了至完全治疗后5年的评估。
如果化疗分别在住院和门诊进行，同步放化疗组的成本效益比分别为每月存活2855泰铢和1835泰铢。放疗组的成本效益比为每月存活2366泰铢。对于敏感性分析，在同步放化疗并不比单纯放疗好很多的情况下，即同步放化疗组的复发率不比放疗组低20%以上，即使化疗在门诊进行，单纯放疗也更具成本效益。
在宫颈癌治疗中，单纯放疗比同步放化疗更具成本效益。然而，如果化疗在门诊进行，只有当同步放化疗组的复发率比放疗组低20%以上时，同步放化疗才更具成本效益。
