Cohn David E, Huh Warner K, Fowler Jeffrey M, Straughn J Michael
Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, Ohio, USA.
Obstet Gynecol. 2007 Jun;109(6):1388-95. doi: 10.1097/01.AOG.0000262897.21628.06.
To estimate the costs and outcomes of various strategies used for the management of grade 1 endometrial cancer.
A cost-effectiveness analysis compared three strategies for the management of grade 1 endometrial cancer: 1) surgical staging in all patients (including hysterectomy and lymphadenectomy); 2) frozen section following hysterectomy with surgical staging based on the results of tumor grade and depth of myometrial invasion; and 3) hysterectomy without surgical staging (no staging). Surgical probabilities and recurrence rates were estimated from published data. Actual payer costs of surgery, radiation therapy, and chemotherapy were estimated for each strategy. Cost-effectiveness ratios were estimated for each strategy. Sensitivity analyses evaluated the costs of radiation and survival estimates used in the model.
For the estimated 10,000 women diagnosed annually with grade 1 endometrial cancer in the United States, the annual cost of surgical staging is $240.4 million, compared with $252.4 million for frozen section and $255.8 million for no staging. Five-year disease-free survival for surgical staging is 87.9%, compared with 87.3% for frozen section and 86.7% for no staging. This translates into a lower cost-effectiveness ratio for surgical staging ($27,337) compared with frozen section ($28,913) or no staging ($29,513). Surgical staging yielded 64 additional disease-free patients per 10,000 patients compared with frozen section and 126 additional disease-free patients compared with no staging. Use of adjuvant radiation therapy was the lowest in the surgical staging strategy (13%).
Surgical staging of all patients with grade 1 endometrial cancer is the most cost-effective strategy and decreases the use of radiation therapy without negatively impacting survival.
评估用于管理1级子宫内膜癌的各种策略的成本和结果。
进行成本效益分析，比较管理1级子宫内膜癌的三种策略：1）对所有患者进行手术分期（包括子宫切除术和淋巴结清扫术）；2）子宫切除术后进行冰冻切片检查，并根据肿瘤分级和肌层浸润深度进行手术分期；3）不进行手术分期的子宫切除术（无分期）。手术概率和复发率根据已发表的数据进行估算。对每种策略估算手术、放疗和化疗的实际支付方成本。估算每种策略的成本效益比。敏感性分析评估模型中使用的放疗成本和生存估计值。
在美国，估计每年有10000名妇女被诊断为1级子宫内膜癌，手术分期的年度成本为2.404亿美元，相比之下，冰冻切片检查为2.524亿美元，无分期为2.558亿美元。手术分期的5年无病生存率为87.9%，相比之下，冰冻切片检查为87.3%，无分期为86.7%。这意味着手术分期的成本效益比（27337美元）低于冰冻切片检查（28913美元）或无分期（29513美元）。与冰冻切片检查相比，手术分期每10000名患者中多产生64名无病患者，与无分期相比多产生126名无病患者。手术分期策略中辅助放疗的使用最低（13%）。
对所有1级子宫内膜癌患者进行手术分期是最具成本效益的策略，可减少放疗的使用，且对生存没有负面影响。
