Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
Department of Medicine, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
Head Neck. 2018 Aug;40(8):1743-1751. doi: 10.1002/hed.25142. Epub 2018 Mar 14.
The purpose of this study was to present our evaluation of the cost-effectiveness of salvage therapies for patients with recurrent head and neck cancer.
A Markov model was developed with 5 salvage treatment strategies: (1) platinum-based chemotherapy alone; (2) chemotherapy plus cetuximab; (3) stereotactic body radiotherapy (SBRT) alone; (4) SBRT plus cetuximab; and (5) intensity-modulated radiotherapy (IMRT) plus chemotherapy. Clinical parameters were obtained from comprehensive literature review and 2016 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER), with effectiveness in quality-adjusted life years (QALYs), and evaluated with a willingness-to-pay (WTP) threshold of $100 000 per QALY gained.
In the base case analysis, no treatment strategy was cost-effective at a WTP threshold. The most cost-effective therapy was SBRT alone with $150 866 per QALY gained. If median survival of SBRT alone was ≥11 months, SBRT was considered to be cost-effective.
None of the treatment strategies were cost-effective. However, SBRT-based reirradiation has potential to be cost-effective.
本研究旨在评估复发性头颈部癌症患者挽救治疗的成本效益。
采用 Markov 模型，提出了 5 种挽救治疗策略：（1）单独使用铂类化疗；（2）化疗联合西妥昔单抗；（3）立体定向体部放疗（SBRT）；（4）SBRT 联合西妥昔单抗；（5）调强放疗（IMRT）联合化疗。临床参数来源于全面的文献复习和 2016 年医疗保险报销。采用增量成本效益比（ICER）比较策略，以质量调整生命年（QALY）为效果，并以每获得 1 个 QALY 支付 100000 美元的意愿支付（WTP）阈值进行评估。
在基础案例分析中，没有一种治疗策略在 WTP 阈值下具有成本效益。最具成本效益的治疗方法是单独使用 SBRT，每获得 1 个 QALY 的成本为 150866 美元。如果单独使用 SBRT 的中位生存时间≥11 个月，则认为 SBRT 具有成本效益。
没有一种治疗策略具有成本效益。然而，基于 SBRT 的再放疗具有潜在的成本效益。
