Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2019 Sep;31(9):e143-e148. doi: 10.1016/j.clon.2019.05.004. Epub 2019 May 31.
Among all malignancies, the use of radiotherapy incurs the highest survival benefit within cervical cancers. Radiotherapy, however, remains underutilised for cervical cancers within the Brazilian public health system (BPHS). The objective of this study was to estimate the potential health and monetary benefits for universal access to radiotherapy and chemoradiotherapy (CRT) for untreated cervical cancer patients in the BPHS.
Using 2016 data on Brazilian cervical cancer incidence and availability of radiotherapy/CRT in the BPHS, the number of cancer deaths due to radiotherapy/CRT underutilisation was estimated. The incremental effectiveness was calculated by life-year gain. The indirect costs from mortality-related productivity loss (MRPL) were estimated based on life expectancy, wage and labour force participation rate. MRPL was compared with direct medical costs after being adjusted to 2016 US dollars. This study was conducted from the payer's perspective; both costs and effectiveness were discounted at a rate of 3%. The incremental cost-effectiveness ratio (ICER) was calculated to determine the cost-effectiveness of radiotherapy for cervical cancer in Brazil. One-way sensitivity analyses were carried out to assess the robustness of the model.
The total number of life-years lost due to lack of universal access to radiotherapy and CRT per year were 27 199 and 31 627, respectively. The annual cost to match the radiotherapy gap was $10.5 million, with an additional cost of $3 million to close the CRT gap. The mean years of potential life lost per death was 20.5. The cost per life saved was $7942 for radiotherapy alone (ICER $388/life-year) and $8774 for CRT (ICER $429/life-year). MRPL due to shortage of radiotherapy and CRT were $59 million and $69 million, respectively.
Providing universal access to radiotherapy/CRT for cervical cancer patients in the BPHS is highly cost-effective and should be prioritised as an impactful public health initiative.
在所有恶性肿瘤中，宫颈癌患者接受放疗可获得最高的生存获益。然而，在巴西公共卫生系统（BPHS）中，宫颈癌患者的放疗使用率仍然较低。本研究旨在评估在 BPHS 中为未经治疗的宫颈癌患者普及放疗和放化疗（CRT）的潜在健康和经济效益。
利用 2016 年巴西宫颈癌发病率和 BPHS 中放疗/CRT 可及性的数据，估算因放疗使用率低而导致的癌症死亡人数。通过生命年获益来计算增量效果。根据预期寿命、工资和劳动力参与率，估算与死亡率相关的生产力损失（MRPL）的间接成本。将 MRPL 调整为 2016 年美元后，与直接医疗费用进行比较。本研究从支付者的角度进行；成本和效果均按 3%贴现。计算增量成本效益比（ICER）以确定巴西宫颈癌放疗的成本效益。进行单因素敏感性分析以评估模型的稳健性。
每年因缺乏普及放疗和 CRT 而导致的生命年损失总数分别为 27199 年和 31627 年。弥补放疗差距的年度成本为 1050 万美元，弥补 CRT 差距的额外成本为 300 万美元。每例死亡导致的潜在生命损失年数平均为 20.5 年。单独进行放疗的成本效益比为每挽救 1 人生命的成本为 7942 美元（ICER 为 388 美元/生命年），进行 CRT 的成本效益比为 8774 美元（ICER 为 429 美元/生命年）。放疗和 CRT 短缺导致的 MRPL 分别为 5900 万美元和 6900 万美元。
在 BPHS 中为宫颈癌患者普及放疗/CRT 具有很高的成本效益，应作为一项有影响力的公共卫生举措予以优先考虑。
