局部区域既往放疗的头颈部癌挽救性治疗的成本效果分析。
Cost-effectiveness analysis of salvage therapies in locoregional previously irradiated head and neck cancer.
机构信息
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.
出版信息
Head Neck. 2018 Aug;40(8):1743-1751. doi: 10.1002/hed.25142. Epub 2018 Mar 14.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
None of the treatment strategies were cost-effective. However, SBRT-based reirradiation has potential to be cost-effective.
背景
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。
方法
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。
结果
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。
结论
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。
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