Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands.
Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Lung Cancer. 2020 Mar;141:89-96. doi: 10.1016/j.lungcan.2020.01.011. Epub 2020 Jan 16.
Stage I non-small cell lung cancer (NSCLC) can be treated with either Stereotactic Body Radiotherapy (SBRT) or Video Assisted Thoracic Surgery (VATS) resection. To support decision making, not only the impact on survival needs to be taken into account, but also on quality of life, costs and cost-effectiveness. Therefore, we performed a cost-effectiveness analysis comparing SBRT to VATS resection with respect to quality adjusted life years (QALY) lived and costs in operable stage I NSCLC.
Patient level and aggregate data from eight Dutch databases were used to estimate costs, health utilities, recurrence free and overall survival. Propensity score matching was used to minimize selection bias in these studies. A microsimulation model predicting lifetime outcomes after treatment in stage I NSCLC patients was used for the cost-effectiveness analysis. Model outcomes for the two treatments were overall survival, QALYs, and total costs. We used a Dutch health care perspective with 1.5 % discounting for health effects, and 4 % discounting for costs, using 2018 cost data. The impact of model parameter uncertainty was assessed with deterministic and probabilistic sensitivity analyses.
Patients receiving either VATS resection or SBRT were estimated to live 5.81 and 5.86 discounted QALYs, respectively. Average discounted lifetime costs in the VATS group were €29,269 versus €21,175 for SBRT. Difference in 90-day excess mortality between SBRT and VATS resection was the main driver for the difference in QALYs. SBRT was dominant in at least 74 % of the probabilistic simulations.
Using a microsimulation model to combine available evidence on survival, costs, and health utilities in a cost-effectiveness analysis for stage I NSCLC led to the conclusion that SBRT dominates VATS resection in the majority of simulations.
Ⅰ期非小细胞肺癌（NSCLC）可采用立体定向放射治疗（SBRT）或电视辅助胸腔镜手术（VATS）切除治疗。为了支持决策，不仅需要考虑对生存的影响，还要考虑生活质量、成本和成本效益。因此，我们进行了一项成本效益分析，比较了 SBRT 和 VATS 切除治疗在可手术的Ⅰ期 NSCLC 中对生存质量调整生命年（QALY）和成本的影响。
使用来自八个荷兰数据库的患者水平和汇总数据来估计成本、健康效用、无复发和总生存。采用倾向评分匹配来最小化这些研究中的选择偏倚。使用预测Ⅰ期 NSCLC 患者治疗后终生结局的微观模拟模型进行成本效益分析。两种治疗方法的模型结果为总生存、QALY 和总费用。我们使用荷兰医疗保健视角，对健康影响贴现 1.5%，对成本贴现 4%，使用 2018 年成本数据。通过确定性和概率敏感性分析评估模型参数不确定性的影响。
接受 VATS 切除或 SBRT 的患者预计分别存活 5.81 和 5.86 个贴现 QALY。VATS 组的平均贴现终身成本为 29269 欧元，而 SBRT 组为 21175 欧元。SBRT 和 VATS 切除组之间 90 天超额死亡率的差异是 QALY 差异的主要驱动因素。在至少 74%的概率模拟中，SBRT 占据优势。
使用微观模拟模型将生存、成本和健康效用方面的可用证据结合到Ⅰ期 NSCLC 的成本效益分析中，得出的结论是，在大多数模拟中，SBRT 优于 VATS 切除。
