Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
World J Surg. 2011 Mar;35(3):662-70. doi: 10.1007/s00268-010-0883-8.
Little is reported on costs for radical tumor resections of pancreatic carcinoma in relationship to adjusted quality of life survival postoperatively. Therefore, the aim of the present study was to estimate the cost utility of surgical treatment aimed at cure.
A population-based cohort of patients with exocrine or ampullary pancreatic adenocarcinoma resected for cure in Gothenburg University Hospitals during 1998-2005 were evaluated retrospectively (n = 139). Total inpatient and outpatient healthcare costs were available for 103 patients, and health-related quality of life (HRQL) (based on the SF-36 Health Survey) were assessed preoperatively and postoperataively in 119 patients. Survival and utility index (SF-36-6D) across 5 years of postoperative follow-up were used to achieve quality adjusted life years.
Mean survival after resection was 977 days for patients with exocrine pancreatic carcinoma, with expected differences among subgroups as related to disease stage (p < 0.01), in agreement with international reports. The HRQL index was 0.65 ± 0.06 preoperatively, 0.63 ± 0.04 early postoperatively (<1 year) and 0.69 ± 0.06 at long-term follow-up (1-5 years) compared to 0.77 ± 0.02 in age-matched healthy reference individuals from the Swedish population (p < 0.05). Total lifetime costs for treatments including surgery and adjuvant chemotherapy were 39,000 euro per patient, with a mean of 1.13 (95% Confidence Interval [CI] 0.93-1.40) QALYs across 5 years follow-up. The cost per QALY was 35,000 euro (95% CI 28,026 euro-41,947 euro).
Resection aimed at cure of pancreatic exocrine ductal carcinoma provided costs for one quality adjusted year of survival comparable to other complex surgical treatments within cost limits regarded as reasonable to bear by the Swedish health care system, as well as in several other Western countries.
关于根治性肿瘤切除术治疗胰腺癌的成本与术后调整后的生存质量之间的关系，相关报道甚少。因此，本研究旨在评估旨在治愈的手术治疗的成本效益。
回顾性分析了 1998 年至 2005 年期间在哥德堡大学医院接受根治性手术治疗的外分泌或壶腹胰腺腺癌患者的人群队列（n=139）。103 例患者可获得总住院和门诊医疗费用，119 例患者可评估术前和术后健康相关生活质量（基于 SF-36 健康调查）。在术后 5 年随访期间，生存和效用指数（SF-36-6D）用于获得质量调整生命年。
外分泌胰腺腺癌患者切除后的平均生存时间为 977 天，与国际报道一致，疾病分期不同的亚组之间存在预期差异（p<0.01）。HRQL 指数为术前 0.65±0.06，术后早期（<1 年）0.63±0.04，长期随访（1-5 年）0.69±0.06，而年龄匹配的瑞典人群健康参考个体为 0.77±0.02（p<0.05）。包括手术和辅助化疗在内的治疗的终身总费用为每位患者 39000 欧元，5 年随访的平均 QALY 为 1.13（95%置信区间[CI]0.93-1.40）。每 QALY 的成本为 35000 欧元（95%CI28026 欧元-41947 欧元）。
根治性切除外分泌胰腺导管腺癌的治疗为每例治愈的生存质量调整后的 1 年提供了成本，这与瑞典医疗保健系统认为合理的其他复杂手术治疗相当，在其他几个西方国家也是如此。
