Duke University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Durham, NC 27710, USA.
Gynecol Oncol. 2013 Sep;130(3):426-30. doi: 10.1016/j.ygyno.2013.06.011. Epub 2013 Jun 14.
To determine if early palliative care intervention in patients with recurrent, platinum-resistant ovarian cancer is potentially cost saving or cost-effective.
A decision model with a 6 month time horizon evaluated routine care versus routine care plus early referral to a palliative medicine specialist (EPC) for recurrent platinum-resistant ovarian cancer. Model parameters included rates of inpatient admissions, emergency department (ED) visits, chemotherapy administration, and quality of life (QOL). From published ovarian cancer data, we assumed baseline rates over the final 6 months: hospitalization 70%, chemotherapy 60%, and ED visit 30%. Published data from a randomized trial evaluating EPC in metastatic lung cancer were used to model odds ratios (ORs) for potential reductions in hospitalization (OR 0.69), chemotherapy (OR 0.77), and emergency department care (OR 0.74) and improvement in QOL (OR 1.07). The costs of hospitalization, ED visit, chemotherapy, and EPC were based on published data. Ranges were used for sensitivity analysis. Effectiveness was quantified in quality adjusted life years (QALYs); survival was assumed equivalent between strategies.
EPC was associated with a cost savings of $1285 per patient over routine care. In sensitivity analysis incorporating QOL, EPC was either dominant or cost-effective, with an incremental cost-effectiveness ratio (ICER) <$50,000/QALY, unless the cost of outpatient EPC exceeded $2400. Assuming no clinical benefit other than QOL (no change in chemotherapy administration, hospitalizations or ED visits), EPC remained highly cost-effective with ICER $37,440/QALY.
Early palliative care intervention has the potential to reduce costs associated with end of life care in patients with ovarian cancer.
确定在复发性铂耐药卵巢癌患者中早期姑息治疗干预是否具有潜在的成本效益。
采用 6 个月时间范围的决策模型，评估常规护理与常规护理加早期转介至姑息医学专家（EPC）治疗复发性铂耐药卵巢癌的情况。模型参数包括住院、急诊就诊、化疗管理和生活质量（QOL）的发生率。从已发表的卵巢癌数据中，我们假设最后 6 个月的基线发生率为：住院 70%、化疗 60%和急诊就诊 30%。使用评估转移性肺癌 EPC 的随机试验的发表数据来对潜在减少住院（OR 0.69）、化疗（OR 0.77）和急诊就诊（OR 0.74）以及改善 QOL（OR 1.07）的几率进行建模。住院、急诊就诊、化疗和 EPC 的成本基于已发表的数据。敏感性分析中使用了范围。有效性以质量调整生命年（QALY）量化；假设两种策略的生存率相同。
与常规护理相比，EPC 使每位患者的成本节省了 1285 美元。在纳入 QOL 的敏感性分析中，EPC 要么具有优势，要么具有成本效益，增量成本效益比（ICER）<50000 美元/QALY，除非门诊 EPC 的成本超过 2400 美元。假设除了 QOL 之外没有临床获益（化疗管理、住院和急诊就诊没有变化），EPC 仍然具有很高的成本效益，ICER 为 37440 美元/QALY。
早期姑息治疗干预有可能降低卵巢癌患者临终关怀相关成本。
