Pollom Erqi L, Lee Kyueun, Durkee Ben Y, Grade Madeline, Mokhtari Daniel A, Wahl Daniel R, Feng Mary, Kothary Nishita, Koong Albert C, Owens Douglas K, Goldhaber-Fiebert Jeremy, Chang Daniel T
From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
Radiology. 2017 May;283(2):460-468. doi: 10.1148/radiol.2016161509. Epub 2017 Jan 3.
Purpose To assess the cost-effectiveness of stereotactic body radiation therapy (SBRT) versus radiofrequency ablation (RFA) for patients with inoperable localized hepatocellular carcinoma (HCC) who are eligible for both SBRT and RFA. Materials and Methods A decision-analytic Markov model was developed for patients with inoperable, localized HCC who were eligible for both RFA and SBRT to evaluate the cost-effectiveness of the following treatment strategies: (a) SBRT as initial treatment followed by SBRT for local progression (SBRT-SBRT), (b) RFA followed by RFA for local progression (RFA-RFA), (c) SBRT followed by RFA for local progression (SBRT-RFA), and (d) RFA followed by SBRT for local progression (RFA-SBRT). Probabilities of disease progression, treatment characteristics, and mortality were derived from published studies. Outcomes included health benefits expressed as discounted quality-adjusted life years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analysis was performed to assess the robustness of the findings. Results In the base case, SBRT-SBRT yielded the most QALYs (1.565) and cost $197 557. RFA-SBRT yielded 1.558 QALYs and cost $193 288. SBRT-SBRT was not cost-effective, at $558 679 per QALY gained relative to RFA-SBRT. RFA-SBRT was the preferred strategy, because RFA-RFA and SBRT-RFA were less effective and more costly. In all evaluated scenarios, SBRT was preferred as salvage therapy for local progression after RFA. Probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100 000 per QALY gained, RFA-SBRT was preferred in 65.8% of simulations. Conclusion SBRT for initial treatment of localized, inoperable HCC is not cost-effective. However, SBRT is the preferred salvage therapy for local progression after RFA. RSNA, 2017 Online supplemental material is available for this article.
目的 评估立体定向体部放射治疗（SBRT）与射频消融（RFA）对符合两种治疗方法的无法手术切除的局限性肝细胞癌（HCC）患者的成本效益。材料与方法 针对符合RFA和SBRT治疗条件的无法手术切除的局限性HCC患者，开发了一种决策分析马尔可夫模型，以评估以下治疗策略的成本效益：（a）SBRT作为初始治疗，局部进展时采用SBRT（SBRT-SBRT），（b）RFA，局部进展时采用RFA（RFA-RFA），（c）SBRT，局部进展时采用RFA（SBRT-RFA），以及（d）RFA，局部进展时采用SBRT（RFA-SBRT）。疾病进展概率、治疗特征和死亡率来自已发表的研究。结果包括以贴现质量调整生命年（QALY）表示的健康效益、以美元计的成本，以及以增量成本效益比表示的成本效益。进行确定性和概率敏感性分析以评估研究结果的稳健性。结果 在基础病例中，SBRT-SBRT产生的QALY最多（1.565），成本为197557美元。RFA-SBRT产生1.558 QALY，成本为193288美元。相对于RFA-SBRT，SBRT-SBRT每获得1个QALY的成本为558679美元，不具有成本效益。RFA-SBRT是首选策略，因为RFA-RFA和SBRT-RFA效果较差且成本更高。在所有评估方案中，SBRT作为RFA后局部进展的挽救治疗更受青睐。概率敏感性分析表明，在每获得1个QALY的支付意愿阈值为100000美元时，RFA-SBRT在65.8%的模拟中更受青睐。结论 SBRT作为局限性、无法手术切除的HCC的初始治疗不具有成本效益。然而，SBRT是RFA后局部进展的首选挽救治疗。RSNA，2017 本文提供在线补充材料。
