Chang Eric M, Shaverdian Narek, Capiro Nina, Steinberg Michael L, Raldow Ann C
Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
J Vasc Interv Radiol. 2020 Aug;31(8):1221-1232. doi: 10.1016/j.jvir.2020.03.027. Epub 2020 Jul 13.
To evaluate the cost effectiveness of incorporating cryoablation in the treatment regimens for uncomplicated bone metastases using radiation therapy (RT) in single-fraction RT (SFRT) or multiple-fraction RT (MFRT) regimens.
A Markov model was constructed using 1-month cycles over a lifetime horizon to compare the cost effectiveness of multiple strategies, including RT followed by RT (RT-RT) for recurrent pain, RT followed by cryoablation (RT-ablation), and cryoablation followed by RT (ablation-RT). RT-RT consisted of 8 Gy in 1 fraction/8 Gy in 1 fraction (SFRT-SFRT) and 30 Gy in 10 fractions/20 Gy in 5 fractions (MFRT-MFRT). Probabilities and utilities were extracted from a search of the medical literature. Costs were calculated from a payer perspective using 2017 Medicare reimbursement in an outpatient setting. Incremental cost effectiveness ratios (ICERs) were calculated using strategies evaluated for willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). To account for model uncertainty, one-way and probabilistic sensitivity analyses were performed.
In the base case analysis, SFRT-ablation was cost effective relative to SFRT-SFRT at $96,387/QALY. MFRT-ablation was cost effective relative to MFRT-MFRT at $85,576/QALY. Ablation-SFRT and ablation-MFRT were not cost effective with ICERs >$100,000/QALY. In one-way sensitivity analyses, results were highly sensitive to variation in multiple model parameters, including median survival (base: 9 months), with SFRT-SFRT favored at median survival ≤8.7 months. Probabilistic sensitivity analysis examining SFRT-based regimens showed that SFRT-ablation was preferred in 36.9% of simulations at WTP of $100,000/QALY.
Cryoablation is a potentially cost-effective alternative to reirradiation with RT for recurrent of pain following RT; however, no strategy incorporating initial cryoablation was cost effective.
评估在单次分割放疗（SFRT）或多次分割放疗（MFRT）方案中，将冷冻消融纳入单纯骨转移瘤放射治疗（RT）方案的成本效益。
构建一个马尔可夫模型，以1个月为周期，覆盖患者的一生，比较多种策略的成本效益，包括针对复发性疼痛的放疗后再放疗（RT-RT）、放疗后冷冻消融（RT-消融）以及冷冻消融后放疗（消融-RT）。RT-RT包括1次分割8 Gy/1次分割8 Gy（SFRT-SFRT）和10次分割30 Gy/5次分割20 Gy（MFRT-MFRT）。从医学文献检索中提取概率和效用值。成本从支付方角度计算，采用2017年门诊环境下的医疗保险报销费用。使用评估策略计算增量成本效益比（ICER），支付意愿阈值为每质量调整生命年（QALY）100,000美元。为考虑模型的不确定性，进行了单向和概率敏感性分析。
在基础病例分析中，SFRT-消融相对于SFRT-SFRT具有成本效益，为96,387美元/QALY。MFRT-消融相对于MFRT-MFRT具有成本效益，为85,576美元/QALY。消融-SFRT和消融-MFRT不具有成本效益，ICER大于100,000美元/QALY。在单向敏感性分析中，结果对多个模型参数的变化高度敏感，包括中位生存期（基础值：9个月），当中位生存期≤8.7个月时，SFRT-SFRT更受青睐。对基于SFRT的方案进行概率敏感性分析表明，在支付意愿为100,000美元/QALY的情况下，36.9%的模拟结果显示SFRT-消融更优。
对于放疗后复发性疼痛，冷冻消融是一种可能具有成本效益的替代再放疗的方法；然而，没有一种包含初始冷冻消融的策略具有成本效益。
