一项成本效用分析比较了大容量移位肿瘤整形手术与乳腺癌乳房切除术联合游离皮瓣重建的治疗效果。
A cost-utility analysis comparing large volume displacement oncoplastic surgery to mastectomy with free flap reconstruction in the treatment of breast cancer.
机构信息
Department of Surgery, Tufts University Medical Center, Boston, MA, USA.
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Am J Surg. 2019 Sep;218(3):597-604. doi: 10.1016/j.amjsurg.2019.01.037. Epub 2019 Jan 31.
PURPOSE
Breast cancer surgical treatment may include large volume displacement oncoplastic surgery (LVOS) or mastectomy with free flap reconstruction (MFFR). We investigated the cost-utility between LVOS versus MFFR to determine which approach was most cost-effective.
METHODS
A literature review was performed to calculate probabilities for clinical outcomes for each surgical option (LVOS versus MFFR), and to obtain utility scores that were converted into quality adjusted life years (QALYs) as measures for clinical effectiveness. Average Medicare payments were surrogates for cost. A decision tree was constructed and an incremental cost-utility ratio (ICUR) was used to calculate cost-effectiveness.
RESULTS
The decision tree demonstrates associated QALYs and costs with probabilities used to calculate the ICUR of $3699/QALY with gain of 2.7 QALY at an additional cost of $9987 proving that LVOS is a cost-effective surgical option. One-way sensitivity analysis showed that LVOS became cost-ineffective when its clinical effectiveness had a QALY of less than 30.187. Tornado Diagram Analysis and Monte-Carlo simulation supported our conclusion.
CONCLUSION
LVOS is cost-effective when compared to MFFR for the appropriate breast cancer patient.
CLINICAL QUESTION/LEVEL OF EVIDENCE: II.
目的
乳腺癌的外科治疗可能包括大容量位移整形手术（LVOS）或乳房切除术加游离皮瓣重建（MFFR）。我们研究了 LVOS 与 MFFR 之间的成本效益，以确定哪种方法最具成本效益。
方法
进行文献回顾，以计算每种手术选择（LVOS 与 MFFR）的临床结果概率，并获得效用评分，这些评分被转换为质量调整生命年（QALYs），作为临床效果的衡量标准。平均医疗保险支付是成本的替代物。构建决策树并使用增量成本效用比（ICUR）计算成本效益。
结果
决策树显示了与概率相关的 QALYs 和成本，用于计算 ICUR 的值为 3699 美元/QALY，增加了 2.7 QALY，额外成本为 9987 美元，证明 LVOS 是一种具有成本效益的手术选择。单因素敏感性分析表明，当 LVOS 的临床效果的 QALY 小于 30.187 时，它就变得不具有成本效益。龙卷风图分析和蒙特卡罗模拟支持我们的结论。
结论
对于合适的乳腺癌患者，LVOS 与 MFFR 相比具有成本效益。
临床问题/证据水平：II。
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