Harvard T. H. Chan School of Public Health, Boston, USA.
Department of Surgery, University of British Columbia, Vancouver, Canada.
Ann Surg Oncol. 2019 Apr;26(4):1110-1117. doi: 10.1245/s10434-018-07111-y. Epub 2019 Jan 28.
Cost-effectiveness evaluations of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis (PC) from metastatic colorectal cancer (mCRC) in the United States are lacking.
The authors developed a Markov model to evaluate the cost-effectiveness of CRS/HIPEC compared with systemic chemotherapy for isolated PC from mCRC from a societal perspective in the United States. The systemic treatment regimens consisted of FOLFOX, FOLFIRI, bevacizumab, cetuximab, and pantitumumab. The model inputs including costs, probabilities, survival, progression, and utilities were taken from the literature. The cycle length for the model was 2 weeks, and the time horizon was 7 years. A discount rate of 3% was applied. The model was tested for internal and external validation, and robustness was established with univariate sensitivity and probabilistic sensitivity analyses (PSA). The primary outcomes were total costs, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratio (ICER). A willingness-to-pay (WTP) threshold of $100,000 per QALY was assumed.
The ICER for treatment with CRS/HIPEC compared with systemic chemotherapy was $91,034 per QALY gained ($74,098 per LY gained). The univariate sensitivity analysis showed that the total costs for treatment with CRS/HIPEC had the largest effect on the calculated ICER. The CRS/HIPEC treatment was a cost-effective strategy during the majority of simulations in the PSA. The average ICER for 100,000 simulations in the PSA was $70,807 per QALY gained. The likelihood of CRS/HIPEC being a cost-effective strategy at the WTP threshold was 87%.
The CRS/HIPEC procedure is a cost-effective treatment for isolated PC from mCRC in the United States.
在美国，针对转移性结直肠癌（mCRC）所致腹膜癌（PC），细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）的成本效果评估数据匮乏。
作者开发了一个马尔可夫模型，从美国社会角度出发，评估了与全身化疗相比，CRS/HIPEC 治疗孤立性 mCRC 所致 PC 的成本效果。全身治疗方案包括 FOLFOX、FOLFIRI、贝伐珠单抗、西妥昔单抗和帕尼单抗。模型输入包括成本、概率、生存、进展和效用，均取自文献。模型周期为 2 周，时间范围为 7 年。采用 3%的贴现率。模型经过内部和外部验证，并通过单变量敏感性和概率敏感性分析（PSA）确定稳健性。主要结果为总费用、质量调整生命年（QALY）、生命年（LY）和增量成本效果比（ICER）。假设 1 QALY 的意愿支付（WTP）阈值为 100000 美元。
与全身化疗相比，CRS/HIPEC 治疗的 ICER 为每获得 1 QALY 需花费 91034 美元（每获得 1 LY 需花费 74098 美元）。单变量敏感性分析显示，CRS/HIPEC 治疗的总费用对计算出的 ICER 影响最大。在 PSA 中，大多数模拟中 CRS/HIPEC 治疗都是一种具有成本效果的策略。PSA 中 100000 次模拟的平均 ICER 为每获得 1 QALY 需花费 70807 美元。在 WTP 阈值下，CRS/HIPEC 治疗具有成本效果的可能性为 87%。
在美国，针对孤立性 mCRC 所致 PC，CRS/HIPEC 手术是一种具有成本效果的治疗方法。
