Louie Alexander V, Rodrigues George B, Palma David A, Senan Suresh
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA.
Oncologist. 2014 Aug;19(8):880-5. doi: 10.1634/theoncologist.2013-0469. Epub 2014 Jun 20.
The Cancer Risk Management Model (CRMM) was used to estimate the health and economic impact of introducing stereotactic ablative radiotherapy (SABR) for stage I non-small cell lung cancer (NSCLC) in Canada.
The CRMM uses Monte Carlo microsimulation representative of all Canadians. Lung cancer outputs were previously validated internally (Statistics Canada) and externally (Canadian Cancer Registry). We updated costs using the Ontario schedule of fees and benefits or the consumer price index to calculate 2013 Canadian dollars, discounted at a 3% rate. The reference model assumed that for stage I NSCLC, 75% of patients undergo surgery (lobectomy, sublobar resection, or pneumonectomy), 12.5% undergo radiotherapy (RT), and 12.5% undergo best supportive care (BSC). SABR was introduced in 2008 as an alternative to sublobar resection, RT, and BSC at rates reflective of the literature. Incremental cost effectiveness ratios (ICERs) were calculated; a willingness-to-pay threshold of $100,000 (all amounts are in Canadian dollars) per quality-adjusted life-year (QALY) was used from the health care payer perspective.
The total cost for 25,085 new cases of lung cancer in 2013 was calculated to be $608,002,599. Mean upfront costs for the 4,318 stage I cases were $7,646.98 for RT, $8,815.55 for SABR, $12,161.17 for sublobar resection, $16,266.12 for lobectomy, $22,940.59 for pneumonectomy, and $14,582.87 for BSC. SABR dominated (higher QALY, lower cost) RT, sublobar resection, and BSC. RT had lower initial costs than SABR that were offset by subsequent costs associated with recurrence. Lobectomy was cost effective when compared with SABR, with an ICER of $55,909.06.
The use of SABR for NSCLC in Canada is projected to result in significant cost savings and survival gains.
癌症风险管理模型（CRMM）用于评估在加拿大对I期非小细胞肺癌（NSCLC）引入立体定向消融放疗（SABR）的健康和经济影响。
CRMM采用代表所有加拿大人的蒙特卡洛微观模拟。肺癌相关产出先前已在内部（加拿大统计局）和外部（加拿大癌症登记处）得到验证。我们使用安大略省的费用和福利表或消费者价格指数更新成本，以计算2013年加元，并按3%的贴现率进行贴现。参考模型假定，对于I期NSCLC患者，75%接受手术（肺叶切除术、肺段切除术或全肺切除术），12.5%接受放疗（RT），12.5%接受最佳支持治疗（BSC）。2008年引入SABR作为肺段切除术、RT和BSC的替代方案，其采用率反映了相关文献。计算了增量成本效益比（ICER）；从医疗保健支付方的角度出发，使用了每质量调整生命年（QALY）100,000加元（所有金额均以加元计）的支付意愿阈值。
2013年25,085例新发肺癌病例的总成本计算为608,002,599加元。4,318例I期病例的平均前期成本分别为：RT为7,646.98加元，SABR为8,815.55加元，肺段切除术为12,161.17加元，肺叶切除术为16,266.12加元，全肺切除术为22,940.59加元，BSC为14,582.87加元。SABR在QALY更高、成本更低方面优于RT、肺段切除术和BSC。RT的初始成本低于SABR，但被随后与复发相关的成本所抵消。与SABR相比，肺叶切除术具有成本效益，ICER为55,909.06加元。
预计在加拿大将SABR用于NSCLC可显著节省成本并提高生存率。
