Wan Xiaomin, Peng Liubao, Ma Jinan, Chen Gannong, Li Yuanjian
Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Clin Ther. 2015 Nov 1;37(11):2515-2526.e5. doi: 10.1016/j.clinthera.2015.09.007. Epub 2015 Oct 21.
A recent meta-analysis by the Early Breast Cancer Trialists' Collaborative Group found significant improvements achieved by postmastectomy radiotherapy (PMRT) for patients with breast cancer with 1 to 3 positive nodes (pN1-3). It is unclear whether PMRT is cost-effective for subgroups of patients with positive nodes.
To determine the cost-effectiveness of PMRT for subgroups of patients with breast cancer with positive nodes.
A semi-Markov model was constructed to estimate the expected lifetime costs, life expectancy, and quality-adjusted life-years for patients receiving or not receiving radiation therapy. Clinical and health utilities data were from meta-analyses by the Early Breast Cancer Trialists' Collaborative Group or randomized clinical trials. Costs were estimated from the perspective of the Chinese society. One-way and probabilistic sensitivity analyses were performed.
The incremental cost-effective ratio was estimated as $7984, $4043, $3572, and $19,021 per quality-adjusted life-year for patients with positive nodes (pN+), patients with pN1-3, patients with pN1-3 who received systemic therapy, and patients with >4 positive nodes (pN4+), respectively. According to World Health Organization recommendations, these incremental cost-effective ratios were judged as cost-effective. However, the results of one-way sensitivity analyses suggested that the results were highly sensitive to the relative effectiveness of PMRT (rate ratio).
We determined that the results were highly sensitive to the rate ratio. However, the addition of PMRT for patients with pN1-3 in China has a reasonable chance to be cost-effective and may be judged as an efficient deployment of limited health resource, and the risk and uncertainty of PMRT are relatively greater for patients with pN4+.
早期乳腺癌试验者协作组最近的一项荟萃分析发现，对于有1至3个阳性淋巴结（pN1-3）的乳腺癌患者，乳房切除术后放疗（PMRT）取得了显著改善。目前尚不清楚PMRT对阳性淋巴结患者亚组是否具有成本效益。
确定PMRT对阳性淋巴结乳腺癌患者亚组的成本效益。
构建一个半马尔可夫模型，以估计接受或不接受放射治疗患者的预期终身成本、预期寿命和质量调整生命年。临床和健康效用数据来自早期乳腺癌试验者协作组的荟萃分析或随机临床试验。成本从中国社会的角度进行估计。进行了单向和概率敏感性分析。
对于阳性淋巴结（pN+）患者、pN1-3患者、接受全身治疗的pN1-3患者以及阳性淋巴结数>4（pN4+）的患者，每质量调整生命年的增量成本效益比分别估计为7984美元、4043美元、3572美元和19021美元。根据世界卫生组织的建议，这些增量成本效益比被判定为具有成本效益。然而，单向敏感性分析结果表明，结果对PMRT的相对有效性（率比）高度敏感。
我们确定结果对率比高度敏感。然而，在中国，为pN1-3患者增加PMRT有合理的机会具有成本效益，并且可以被视为有限卫生资源的有效配置，而对于pN4+患者，PMRT的风险和不确定性相对更大。
