Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
Cancer. 2013 Sep 1;119(17):3123-32. doi: 10.1002/cncr.28131. Epub 2013 May 29.
The traditional treatment for clearly operable (CO) patients with stage I non-small cell lung cancer (NSCLC) is lobectomy, with wedge resection (WR) and stereotactic body radiation therapy (SBRT) serving as alternatives in marginally operable (MO) patients. Given an aging population with an increasing prevalence of screening, it is likely that progressively more people will be diagnosed with stage I NSCLC, and thus it is critical to compare the cost-effectiveness of these treatments.
A Markov model was created to compare the cost-effectiveness of SBRT with WR and lobectomy for MO and CO patients, respectively. Disease, treatment, and toxicity data were extracted from the literature and varied in sensitivity analyses. A payer (Medicare) perspective was used.
In the base case, SBRT (MO cohort), SBRT (CO cohort), WR, and lobectomy were associated with mean cost and quality-adjusted life expectancies of $42,094/8.03, $40,107/8.21, $51,487/7.93, and $49,093/8.89, respectively. In MO patients, SBRT was the dominant and thus cost-effective strategy. This result was confirmed in most deterministic sensitivity analyses as well as probabilistic sensitivity analysis, in which SBRT was most likely cost-effective up to a willingness-to-pay of more than $500,000/quality-adjusted life year. For CO patients, lobectomy was the cost-effective treatment option in the base case (incremental cost-effectiveness ratio of $13,216/quality-adjusted life year) and in nearly every sensitivity analysis.
SBRT was nearly always the most cost-effective treatment strategy for MO patients with stage I NSCLC. In contrast, for patients with CO disease, lobectomy was the most cost-effective option.
对于明确可手术（CO）的Ⅰ期非小细胞肺癌（NSCLC）患者，传统的治疗方法是肺叶切除术，而楔形切除术（WR）和立体定向体部放射治疗（SBRT）则是边缘可手术（MO）患者的替代方法。由于人口老龄化以及筛查的普及，越来越多的人可能会被诊断为Ⅰ期 NSCLC，因此比较这些治疗方法的成本效益至关重要。
我们建立了一个 Markov 模型，以比较 SBRT 与 WR 和肺叶切除术分别用于 MO 和 CO 患者的成本效益。从文献中提取疾病、治疗和毒性数据，并在敏感性分析中进行了变化。采用支付者（医疗保险）的观点。
在基线情况下，SBRT（MO 队列）、SBRT（CO 队列）、WR 和肺叶切除术的平均成本和质量调整生命预期分别为 42094 美元/8.03 年、40107 美元/8.21 年、51487 美元/7.93 年和 49093 美元/8.89 年。在 MO 患者中，SBRT 是主导的、具有成本效益的策略。这一结果在大多数确定性敏感性分析以及概率敏感性分析中得到了证实，在这些分析中，SBRT 最有可能在支付意愿超过 500000 美元/质量调整生命年时具有成本效益。对于 CO 患者，肺叶切除术是基线情况下具有成本效益的治疗选择（增量成本效益比为 13216 美元/质量调整生命年），并且在几乎所有敏感性分析中都是如此。
对于 MO 期Ⅰ期 NSCLC 患者，SBRT 几乎总是最具成本效益的治疗策略。相比之下，对于 CO 疾病患者，肺叶切除术是最具成本效益的选择。
