Voigt Jeffrey D, Barnett Gene
99 Glenwood Rd, Ridgewood, NJ 07450 USA.
The Rose Ella Burkhardt Chair in Neurosurgical Oncology, The Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic S73, 9500 Euclid Avenue, Cleveland, OH 44195 USA ; Department of Neurological Surgery, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center Cleveland Clinic Neurological Institute, The Cleveland Clinic, S73, 9500 Euclid Avenue, Cleveland, OH 44195 USA.
Cost Eff Resour Alloc. 2016 Mar 21;14:6. doi: 10.1186/s12962-016-0055-2. eCollection 2016.
The objective of this analysis was to determine the value (incremental cost/increment benefit) of a brain LITT system versus employing current surgical options recommended by NCCN guidelines, specifically open resection (i.e. craniotomy) methods or biopsy (collectively termed CURRENT TREATMENTS) in patients where maximal safe resection may not be feasible. As has been demonstrated in the literature, extent of resection/ablation with minimal complications are independently related to overall survival.
A cost effectiveness analysis from a societal perspective was employed using TreeAge Pro 2014 software. Direct costs (using national average Medicare reimbursement amounts), outcomes (overall survival), and value [defined as increment cost/incremental survival-evaluated as cost/life year gained (LYG)] were evaluated. Sensitivity analysis was also performed to determine which variables had the largest effect on incremental costs and outcomes.
In the base case, the overall survival was improved with brain LITT versus CURRENT TREATMENTS by 3.07 months at an additional cost of $7508 (or $29,340/LYG). This amount was significantly less than the current international threshold value for $32,575/LYG and considerably less than the US threshold value of $50,000/LYG. This incremental cost may also qualify under NICE criteria for end of life therapies. In sensitivity analysis: As percent local recurrence GBM increased; cost of DRG25/26 increased; percent GTR increased; and gliadel use increased-the value of brain LITT improved. Additionally, in those patients where a biopsy is the only option, brain LITT extended life by 7 months.
Brain LITT should be considered a viable option for treatment of high grade gliomas as it improves survival at a cost which appears to be of good value to society. This incremental cost is less than the international and US thresholds for good value.
本分析的目的是确定在无法进行最大安全切除的患者中，脑部激光间质热疗（LITT）系统相对于采用美国国立综合癌症网络（NCCN）指南推荐的当前手术方案（特别是开放性切除术，即开颅手术方法或活检，统称为“当前治疗方法”）的价值（增量成本/增量效益）。正如文献中所表明的，切除/消融范围广且并发症少与总体生存率独立相关。
从社会角度进行成本效益分析，使用TreeAge Pro 2014软件。评估直接成本（使用全国平均医疗保险报销金额）、结果（总体生存率）和价值[定义为增量成本/增量生存，以成本/获得的生命年（LYG）评估]。还进行了敏感性分析，以确定哪些变量对增量成本和结果影响最大。
在基础案例中，与当前治疗方法相比，脑部LITT可使总体生存率提高3.07个月，额外成本为7508美元（或29340美元/LYG）。这一金额明显低于当前国际上每LYG 32575美元的阈值，也远低于美国每LYG 50000美元的阈值。这一增量成本也可能符合英国国家卫生与临床优化研究所（NICE）终末期治疗的标准。在敏感性分析中：随着胶质母细胞瘤（GBM）局部复发百分比增加；诊断相关分组（DRG）25/26成本增加；完全切除（GTR）百分比增加；以及使用卡莫司汀植入剂增加，脑部LITT的价值提高。此外，在那些活检是唯一选择的患者中，脑部LITT可延长生命7个月。
脑部LITT应被视为治疗高级别胶质瘤的可行选择，因为它能提高生存率，且成本对社会而言似乎具有良好价值。这一增量成本低于国际和美国关于良好价值的阈值。
