Bristow Robert E, Santillan Antonio, Diaz-Montes Teresa P, Gardner Ginger J, Giuntoli Robert L, Peeler Susan T
The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Gynecol Oncol. 2007 Mar;104(3):739-46. doi: 10.1016/j.ygyno.2006.09.029. Epub 2006 Nov 13.
To evaluate the cost-effectiveness of an adhesion prevention strategy compared to routine care, in which no adhesion prevention measures are taken, through a decision analysis model in the clinical setting of patients undergoing radical hysterectomy and pelvic lymphadenectomy for Stage IB cervical cancer.
A decision analysis model compared two strategies to manage the risk of adhesion-related morbidity following radical hysterectomy for Stage IB cervical cancer: (1) routine care with no adhesion prevention measures, and (2) the intervention strategy with a HA-CMC anti-adhesion barrier. The cost-effectiveness of each strategy was evaluated from the perspective of society and that of a third party payer.
From the perspective of society, the HA-CMC strategy had an overall cost per patient of $1932 and effectiveness of 7.901 QALYs and dominated the routine care strategy, which had a cost per patient of $3043 and effectiveness of 7.805 QALYs. From the perspective of a third party payer, the HA-CMC strategy had an overall cost per patient of $1247 and effectiveness of 7.987 QALYs and dominated the routine care strategy, which had a cost per patient of $1629 and effectiveness of 7.970 QALYs. A series of one-way sensitivity analyses confirmed the robustness of the model.
Under a conservative set of clinical and economic assumptions, an adhesion prevention strategy utilizing a HA-CMC barrier in patients undergoing radical hysterectomy for Stage IB cervical cancer is cost-effective from both the perspective of society as a whole and that of a third party payer.
通过决策分析模型，在接受IB期宫颈癌根治性子宫切除术和盆腔淋巴结清扫术的患者临床环境中，评估与未采取粘连预防措施的常规护理相比，粘连预防策略的成本效益。
决策分析模型比较了两种管理IB期宫颈癌根治性子宫切除术后粘连相关发病风险的策略：（1）不采取粘连预防措施的常规护理，以及（2）使用透明质酸-羧甲基纤维素（HA-CMC）抗粘连屏障的干预策略。从社会和第三方支付者的角度评估了每种策略的成本效益。
从社会角度来看，HA-CMC策略每位患者的总成本为1932美元，效果为7.901个质量调整生命年（QALY），优于常规护理策略，常规护理策略每位患者的成本为3043美元，效果为7.805个QALY。从第三方支付者的角度来看，HA-CMC策略每位患者的总成本为1247美元，效果为7.987个QALY，优于常规护理策略，常规护理策略每位患者的成本为1629美元，效果为7.970个QALY。一系列单向敏感性分析证实了模型的稳健性。
在一组保守的临床和经济假设下，对于接受IB期宫颈癌根治性子宫切除术的患者，使用HA-CMC屏障的粘连预防策略从整个社会和第三方支付者的角度来看都是具有成本效益的。
