Rognoni Carla, Ciani Oriana, Sommariva Silvia, Tarricone Rosanna
Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy; Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, South Cloisters St Luke's Campus, Exeter, UK.
Value Health. 2017 Mar;20(3):336-344. doi: 10.1016/j.jval.2016.09.2397. Epub 2016 Nov 4.
To perform a cost-effectiveness analysis comparing the use of transarterial radioembolization (TARE) with that of sorafenib in the treatment of patients with intermediate or advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer staging system.
Patient-level data were consecutively recorded and collected at three oncology centers in Italy. A propensity score matching was performed to compare patients with similar clinical characteristics who underwent TARE or sorafenib treatment. Clinical data from the matched cohorts were used to populate a Markov model to project, on a lifetime horizon, life years, quality-adjusted life years, and economic outcomes associated with TARE and sorafenib for both intermediate and advanced HCC stages.
Starting from data covering 389 and 241 patients who underwent TARE and sorafenib treatment, respectively, the propensity score matching yielded a total of 308 matched patients. For intermediate-stage patients, the model estimated for TARE versus sorafenib an incremental cost-utility ratio of €3,302/QALY (incremental cost-effectiveness ratio of €1,865 per life year gained), whereas for patients in advanced stage TARE dominated (lower costs and greater health improvements) compared with sorafenib.
From an Italian health care service perspective, TARE could be a cost-effective strategy in comparison with sorafenib for patients with intermediate or advanced HCC. The results from forthcoming randomized controlled trials comparing TARE with sorafenib will be able to confirm or reject the validity of this preliminary evaluation. In the meantime, decision makers can use these results to control and coordinate the diffusion of the technology.
根据巴塞罗那临床肝癌分期系统，对经动脉放射性栓塞（TARE）与索拉非尼治疗中晚期肝细胞癌（HCC）患者进行成本效益分析。
在意大利的三个肿瘤中心连续记录和收集患者层面的数据。进行倾向评分匹配，以比较接受TARE或索拉非尼治疗的具有相似临床特征的患者。匹配队列的临床数据用于构建马尔可夫模型，以预测在整个生命周期内，TARE和索拉非尼治疗中晚期HCC患者的生命年、质量调整生命年和经济结果。
从分别涵盖389例接受TARE治疗和241例接受索拉非尼治疗的患者的数据开始，倾向评分匹配产生了总共308例匹配患者。对于中期患者，模型估计TARE与索拉非尼相比的增量成本效用比为3302欧元/质量调整生命年（每获得一个生命年的增量成本效益比为1865欧元），而对于晚期患者，与索拉非尼相比，TARE占优势（成本更低且健康改善更大）。
从意大利医疗服务的角度来看，与索拉非尼相比，TARE对于中晚期HCC患者可能是一种具有成本效益的策略。即将进行的比较TARE与索拉非尼的随机对照试验结果将能够证实或否定这一初步评估的有效性。与此同时，决策者可以利用这些结果来控制和协调该技术的推广。
