Fateen Waleed, Khan Farooq, O'Neill Richard J, James Martin W, Ryder Stephen D, Aithal Guruprasad P
NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham.
Nottingham Digestive Diseases Centre, University of Nottingham.
J Hepatocell Carcinoma. 2017 Oct 16;4:123-130. doi: 10.2147/JHC.S144068. eCollection 2017.
A meta-analysis comparing drug-eluting beads transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (cTACE) has recently been published. On balance, no significant differences were found in terms of objective response and overall survival. The impact on healthcare costs had been studied in small series based on a hypothetical model and was in favor of DEB-TACE. We aimed to evaluate and compare health-care costs and effectiveness of both modalities in a cohort of patients from Nottingham, UK.
Using a dedicated radiology database, we identified all patients who had undergone cTACE or DEB-TACE between 2006 and 2012 at a single tertiary referral center based in Nottingham. We collected clinical data, including treatment response, postprocedure complications and 30-day mortality. Costing models were constructed to present both our local hospital perspective as well as the national health service position.
During our study period, 101 procedures were performed on 43 patients (76 cTACE procedures on 26 patients and 25 DEB-TACE procedures on 17 patients). Overall, 11/26 in cTACE and 5/17 in DEB-TACE group had progressive disease (=0.52). Adverse events were seen in 6/76 cTACE compared with 7/25 DEB-TACE group (=0.16). Based on the predetermined standard pathway there was an unadjusted average cost difference of £3770.30 (TACE =£9070.44, DEB-TACE =£5300.14) in favor of the DEB-TACE. Results from our costing models indicated a £2715.33 (95% CI £580.88-4849.77) cost difference in favor of the same procedure.
Even when the extra costs of DEB-TACE were considered, the overall treatment costs per patient were lower in relation to cTACE.
最近发表了一项比较药物洗脱微球经动脉化疗栓塞术（DEB-TACE）与传统经动脉化疗栓塞术（cTACE）的荟萃分析。总体而言，在客观缓解率和总生存期方面未发现显著差异。基于假设模型的小样本研究探讨了对医疗成本的影响，结果支持DEB-TACE。我们旨在评估和比较英国诺丁汉一组患者中这两种治疗方式的医疗成本和有效性。
利用一个专门的放射学数据库，我们确定了2006年至2012年间在诺丁汉的一家单一三级转诊中心接受cTACE或DEB-TACE治疗的所有患者。我们收集了临床数据，包括治疗反应、术后并发症和30天死亡率。构建成本模型以呈现我们当地医院的视角以及国家卫生服务的立场。
在我们的研究期间，对43例患者进行了101次手术（26例患者进行了76次cTACE手术，17例患者进行了25次DEB-TACE手术）。总体而言，cTACE组26例中有11例、DEB-TACE组17例中有5例疾病进展（P=0.52）。cTACE组76例中有6例出现不良事件，而DEB-TACE组25例中有7例（P=0.16）。根据预定的标准路径，未调整的平均成本差异为3770.30英镑（TACE=9070.44英镑，DEB-TACE=5300.14英镑），支持DEB-TACE。我们成本模型的结果表明，支持同一手术方式的成本差异为2715.33英镑（95%CI 580.88-4849.77英镑）。
即使考虑到DEB-TACE的额外成本，每位患者的总体治疗成本相对于cTACE仍较低。
