Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada.
Gynecol Oncol. 2016 Jan;140(1):83-9. doi: 10.1016/j.ygyno.2015.11.007. Epub 2015 Nov 6.
To assess the cost-effectiveness of two commonly used strategies and an alternative triage strategy for patients with Stage IB cervical cancer in the U.S., Canada, and Korea.
A Markov state-transition model was constructed to compare three strategies: (1) radical hysterectomy followed by tailored adjuvant therapy (primary surgery), (2) primary chemoradiation, and (3) an MRI-based triage strategy, in which patients without risk factors in preoperative MRI undergo primary surgery and those with risk factors undergo primary chemoradiation. All relevant literature was identified to extract the probability data. Cost data were calculated from the perspective of U.S., Canadian, and Korean payers. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Cost-effectiveness ratios were analyzed separately using data from each country.
Base case analysis showed that the triage strategy was the most cost-effective of the three strategies in all countries at usual willingness-to-pay threshold (Korea: $30,000 per quality-adjusted life year (QALY), Canada and US: $100,000 per QALY). Monte Carlo simulation acceptability curves from Korea indicated that at a willingness-to-pay threshold of $30,000/QALY, triage strategy was the treatment of choice in 71% of simulations. Monte Carlo simulation acceptability curves from US and Canada indicated that at a willingness-to-pay threshold of $100,000/QALY, triage strategy was the treatment of choice in more than half of simulations.
An MRI-based triage strategy was shown to be more cost-effective than primary surgery or primary chemoradiation in the US, Canada, and Korea.
评估美国、加拿大和韩国ⅠB 期宫颈癌患者的两种常用策略和一种替代分诊策略的成本效益。
构建马尔可夫状态转移模型，以比较三种策略：（1）根治性子宫切除术加个体化辅助治疗（主要手术）；（2）初始放化疗；（3）基于 MRI 的分诊策略，术前 MRI 无危险因素的患者行主要手术，有危险因素的患者行初始放化疗。所有相关文献均被确定以提取概率数据。成本数据从美国、加拿大和韩国支付者的角度进行计算。使用增量成本效益比（ICER）比较策略。使用来自每个国家的数据分别分析成本效益比。
在通常的意愿支付阈值下（韩国：每质量调整生命年 30000 美元，加拿大和美国：每质量调整生命年 100000 美元），在所有国家中，分诊策略都是三种策略中最具成本效益的。来自韩国的蒙特卡罗模拟可接受性曲线表明，在意愿支付阈值为 30000 美元/QALY 时，分诊策略在 71%的模拟中是首选治疗方法。来自美国和加拿大的蒙特卡罗模拟可接受性曲线表明，在意愿支付阈值为 100000 美元/QALY 时，在超过一半的模拟中，分诊策略是首选治疗方法。
在加拿大、美国和韩国，基于 MRI 的分诊策略在成本效益方面优于主要手术或初始放化疗。
