See William A
Urol Oncol. 2014 Nov;32(8):1350-1. doi: 10.1016/j.urolonc.2014.03.019.
To evaluate the safety, tolerability and effectiveness of outpatient (office-based) laser ablation (OLA), with local anaesthetic, for non-muscle-invasive bladder cancer (NMIBC) in an elderly population with and without photodynamic diagnosis (PDD). To compare the cost-effectiveness of OLA of NMIBC with that of inpatient cystodiathermy (IC).
We conducted a prospective cohort study of patients with NMIBC treated with OLA by one consultant surgeon between March 2008 and July 2011. A subgroup of patients had PDD before undergoing OLA. Safety and effectiveness were determined by complications (In the immediate post operative period, at three days and at three months), patient tolerability (visual analogue score) and recurrence rates. The long-term costs and cost-effectiveness of OLA and IC of NMIBC were evaluated using Markov modeling.
A total of 74 OLA procedures (44 white-light, 30 PDD) were carried out in 54 patients. The mean (range) patient age was 77 (52-95) years. More than half of the patients had more than three comorbidities. Previous tumour histology ranged from G1pTa to T3. One patient had haematuria for 1 week which settled spontaneously and did not require hospital admission. There were no other complications. The procedure was well tolerated with pain scores of 0-2/10. Additional lesions were found in 21% of patients using PDD that were not found using white light. At 3 months, the percentage of patients who had recurrence after OLA with white light and OLA with PDD were 10.6 and 4.3%, respectively. At 1 year, 65.1% and 46.9% of patients had recurrence. The cost of OLA was found to be much lower than that of IC (£ 538 vs £ 1474), even with the addition of PDD (£ 912 vs £ 1844). Over the course of a patient's lifetime, OLA was more clinically effective, measured in quality-adjusted life-years (QALY), than IC (0.147 [sd 0.059]) and less costly (£ 2576.42 [sd £ 7293.07]). At a cost-effectiveness threshold of £ 30,000/QALY, as set by the National Institute for Health and Care Excellence, there was an 82% probability that OLA was cost-effective.
This is the first study to demonstrate the long-term cost-effectiveness of OLA of NMIBC. The results support the use of OLA for the treatment of NMIBC, especially in the elderly.
评估在有或没有光动力诊断（PDD）的老年人群中，采用局部麻醉的门诊（基于诊室）激光消融术（OLA）治疗非肌层浸润性膀胱癌（NMIBC）的安全性、耐受性和有效性。比较NMIBC的OLA与住院膀胱电切术（IC）的成本效益。
我们对2008年3月至2011年7月间由一名顾问外科医生采用OLA治疗的NMIBC患者进行了一项前瞻性队列研究。一组患者在接受OLA前进行了PDD。通过并发症（术后即刻、三天和三个月时）、患者耐受性（视觉模拟评分）和复发率来确定安全性和有效性。使用马尔可夫模型评估NMIBC的OLA和IC的长期成本及成本效益。
共对54例患者进行了74次OLA手术（44次白光手术，30次PDD手术）。患者平均（范围）年龄为77（52 - 95）岁。超过一半的患者有三种以上合并症。既往肿瘤组织学类型从G1pTa到T3。一名患者出现血尿1周，自行缓解，无需住院治疗。无其他并发症。该手术耐受性良好，疼痛评分为0 - 2/10。使用PDD发现21%的患者有额外病变，而白光检查未发现。3个月时，白光OLA和PDD OLA术后复发的患者百分比分别为10.6%和4.3%。1年时，复发患者百分比分别为65.1%和46.9%。发现OLA的成本远低于IC（538英镑对1474英镑），即使加上PDD（912英镑对1844英镑）也是如此。在患者的一生中，以质量调整生命年（QALY）衡量，OLA在临床效果上比IC更有效（0.147[标准差0.059]）且成本更低（2576.42英镑[标准差7293.07英镑]）。按照英国国家卫生与临床优化研究所设定 的30000英镑/QALY的成本效益阈值，OLA有82%的概率具有成本效益。
这是第一项证明NMIBC的OLA具有长期成本效益的研究。结果支持使用OLA治疗NMIBC，尤其是在老年患者中。
