使用以患者为中心的结果指标和基于时间驱动作业成本法来定义前列腺近距离放射治疗的价值框架。
Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing.
作者信息
Thaker Nikhil G, Pugh Thomas J, Mahmood Usama, Choi Seungtaek, Spinks Tracy E, Martin Neil E, Sio Terence T, Kudchadker Rajat J, Kaplan Robert S, Kuban Deborah A, Swanson David A, Orio Peter F, Zelefsky Michael J, Cox Brett W, Potters Louis, Buchholz Thomas A, Feeley Thomas W, Frank Steven J
机构信息
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Brachytherapy. 2016 May-Jun;15(3):274-282. doi: 10.1016/j.brachy.2016.01.003. Epub 2016 Feb 23.
PURPOSE
Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework.
METHODS AND MATERIALS
Patients with low-risk PCa treated with low-dose-rate PBT between 1998 and 2009 were included. Outcomes were recorded according to the International Consortium for Health Outcomes Measurement standard set, which includes acute toxicity, patient-reported outcomes, and recurrence and survival outcomes. Patient-level costs to 1 year after PBT were collected using TDABC. Process mapping and radar chart analyses were conducted to visualize this value framework.
RESULTS
A total of 238 men were eligible for analysis. Median age was 64 (range, 46-81). Median followup was 5 years (0.5-12.1). There were no acute Grade 3-5 complications. Expanded Prostate Cancer Index Composite 50 scores were favorable, with no clinically significant changes from baseline to last followup at 48 months for urinary incontinence/bother, bowel bother, sexual function, and vitality. Ten-year outcomes were favorable, including biochemical failure-free survival of 84.1%, metastasis-free survival 99.6%, PCa-specific survival 100%, and overall survival 88.6%. TDABC analysis demonstrated low resource utilization for PBT, with 41% and 10% of costs occurring in the operating room and with the MRI scan, respectively. The radar chart allowed direct visualization of outcomes and costs.
CONCLUSIONS
We successfully created a visual framework to define the value of PBT using the International Consortium for Health Outcomes Measurement standard set and TDABC costs. PBT is associated with excellent outcomes and low costs. Widespread adoption of this methodology will enable value comparisons across providers, institutions, and treatment modalities.
目的
价值被定义为结果与成本之比，已被提议作为评估前列腺癌（PCa）治疗的一项指标。我们分析了前列腺近距离放射治疗（PBT）的标准化结果和时间驱动作业成本法（TDABC），以定义一个价值框架。
方法和材料
纳入1998年至2009年间接受低剂量率PBT治疗的低风险PCa患者。根据国际健康结果测量协会标准集记录结果，该标准集包括急性毒性、患者报告的结果以及复发和生存结果。使用TDABC收集PBT后1年的患者层面成本。进行流程映射和雷达图分析以直观呈现该价值框架。
结果
共有238名男性符合分析条件。中位年龄为64岁（范围46 - 81岁）。中位随访时间为5年（0.5 - 12.1年）。无3 - 5级急性并发症。扩展前列腺癌指数综合评分良好，从基线到48个月最后一次随访时，尿失禁/困扰、肠道困扰、性功能和活力方面均无临床显著变化。10年结果良好，包括无生化失败生存率为84.1%，无转移生存率为99.6%，前列腺癌特异性生存率为100%，总生存率为88.6%。TDABC分析表明PBT的资源利用率较低，分别有41%和10%的成本发生在手术室和MRI扫描中。雷达图能够直接直观呈现结果和成本。
结论
我们成功创建了一个直观框架，使用国际健康结果测量协会标准集和TDABC成本来定义PBT的价值。PBT具有良好的结果和低成本。广泛采用这种方法将能够在不同提供者、机构和治疗方式之间进行价值比较。
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