Fu Terence S, Yao Christopher M K L, Ziai Hedyeh, Monteiro Eric, Almeida Joao Paulo, Zadeh Gelareh, Gentili Fred, de Almeida John R
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
Head Neck. 2021 Jan;43(1):79-88. doi: 10.1002/hed.26462. Epub 2020 Sep 12.
Endoscopic endonasal approaches (EEAs) have been adopted as an alternative to standard transcranial approaches for olfactory groove meningiomas (OGMs). However, the relative cost-effectiveness remains controversial.
Cost-utility analysis from a societal perspective comparing EEA vs transcranial approaches for OGM was used in this study. Surgical treatment was modeled using decision analysis, and a Markov model was adopted over a 20-year horizon. Parameters were obtained from literature review. Costs were expressed in 2017 Canadian dollars.
In the base case, EEA was cost-effective compared with transcranial surgery with an incremental cost-effectiveness ratio of $33 523 ($30 475 USD)/QALY. There was a 55% likelihood that EEA was cost-effective at a willingness-to-pay of $50 000/QALY. EEA remained cost-effective at a cerebrospinal fluid leak rate below 60%, gross total resection rate above 25%, and base cost less than $66 174 ($60 158 USD).
EEA may be a cost-effective alternative to transcranial approaches for selected OGM.
鼻内镜经鼻入路（EEA）已被用作嗅沟脑膜瘤（OGM）标准经颅入路的替代方法。然而，其相对成本效益仍存在争议。
本研究采用从社会角度对EEA与OGM经颅入路进行比较的成本效用分析。使用决策分析对手术治疗进行建模，并采用马尔可夫模型，时间跨度为20年。参数通过文献综述获得。成本以2017年加拿大元表示。
在基础病例中，与经颅手术相比，EEA具有成本效益，增量成本效益比为33523加元（30475美元）/质量调整生命年。在支付意愿为50000加元/质量调整生命年时，EEA有55%的可能性具有成本效益。当脑脊液漏率低于60%、全切除率高于25%且基础成本低于66174加元（60158美元）时，EEA仍具有成本效益。
对于特定的OGM，EEA可能是经颅入路的一种具有成本效益的替代方法。
