Division of Gynecologic Oncology, University of Alabama at Birmingham, USA.
Gynecol Oncol. 2012 Sep;126(3):364-8. doi: 10.1016/j.ygyno.2012.05.027. Epub 2012 May 30.
To develop a cost-minimization analysis of a multivariate index assay (MIA) used for women with complex pelvic masses.
A decision analysis model was used to evaluate 81,000 hypothetical patients with a complex pelvic mass requiring surgery. Three strategies were evaluated: (1) referral to a gynecologic oncologist (GO) based on clinical assessment including physical exam, ultrasonography, and CA125 (CLINICAL); (2) utilization of a multivariate index assay (MIA); or (3) referral of all patients to a GO (REFER ALL). Various reoperation rates were evaluated with sensitivity analyses. Actual payer costs were compared between each strategy.
The CLINICAL strategy cost $933.9 million (M) and resulted in 72% of patients receiving appropriate initial surgical staging. The REFER ALL strategy cost $939.7 M and all patients were appropriately staged. The MIA strategy cost $976.7 M and resulted in 91% of patients having appropriate initial staging. Using conservative reoperation rates (10-20%), 461 patients required reoperation using CLINICAL strategy compared to 142 patients in MIA strategy. Using aggressive reoperation rates (40-50%), 1715 patients required reoperation using CLINICAL strategy resulting in an incremental cost of $15.2M compared to 529 patients at $4.7 M in MIA strategy. The increased costs associated with an aggressive reoperation rate resulted in the REFER ALL strategy being the least expensive alternative, with the highest rates of appropriate initial surgery.
Utilizing an MIA resulted in more ovarian cancer patients receiving appropriate initial surgery, but at increased costs. Referring all patients with complex masses avoids the most reoperations at reduced cost compared to using an MIA.
对用于复杂盆腔肿块女性的多变量指标检测（MIA）进行成本最小化分析。
使用决策分析模型评估 81000 名需要手术的复杂盆腔肿块假设患者。评估了三种策略：（1）根据包括体格检查、超声和 CA125 在内的临床评估转介给妇科肿瘤学家（GO）（CLINICAL）；（2）使用多变量指标检测（MIA）；或（3）将所有患者转介给 GO（REFER ALL）。通过敏感性分析评估了各种再次手术率。比较了每个策略之间的实际支付者成本。
CLINICAL 策略的成本为 9.339 亿美元，导致 72%的患者接受了适当的初始手术分期。REFER ALL 策略的成本为 9.397 亿美元，所有患者均进行了适当的分期。MIA 策略的成本为 9.767 亿美元，导致 91%的患者进行了适当的初始分期。使用保守的再次手术率（10-20%），CLINICAL 策略需要对 461 名患者进行再次手术，而 MIA 策略只需对 142 名患者进行再次手术。使用激进的再次手术率（40-50%），CLINICAL 策略需要对 1715 名患者进行再次手术，导致增量成本为 1.52 亿美元，而 MIA 策略仅需对 529 名患者进行 4700 万美元的再次手术。由于激进的再次手术率而导致的增加的成本使得 REFER ALL 策略成为最便宜的选择，具有最高的初始手术适当率。
使用 MIA 导致更多的卵巢癌患者接受适当的初始手术，但成本增加。与使用 MIA 相比，将所有患有复杂肿块的患者转介可以避免大多数再次手术，同时降低成本。
