Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
Dis Esophagus. 2021 Aug 10;34(8). doi: 10.1093/dote/doaa116.
The question as to whether the clinical benefits of video-assisted thoracoscopic esophagectomy (VATE) do outweigh its increased costs remains unanswered. Here, we analyzed the cost-effectiveness of VATE versus open esophagectomy (OE) in a real-world setting. Using 2008-2015 Taiwanese Health Insurance claim data, we identified 3271 patients with esophageal cancer who underwent transthoracic esophagectomy. By taking into account nine confounding variables, we constructed a 1:1 propensity score-matched sample of patients who underwent VATE or OE (n = 629 each). Direct costs incurred within three years after surgery and survival were analyzed. There were no significant intergroup differences in terms of R0 resection rates, length of stay, as well as 30- and 90-day mortality and unplanned readmission rates. However, the number of dissected nodes was higher in the VATE group (median: 24 vs. 18, P < 0.001). While VATE had higher index hospitalization costs (median, 12331 USD vs. 10730 USD, P < 0.001), cost differences were reduced over time. The average accumulated cost person-month of VATE declined below that of OE at 14 months after hospital discharge. Overall survival (OS) figures were more favorable for patients treated with VATE (3-year OS: 47% vs. 41%; life expectancy: 4.04 life-years [LY] vs. 3.30 LY). The cost-effectiveness plane showed that only 0.3% of all VATE procedures were more costly and less effective than OE. The probabilities for VATE to be cost-effective at the willingness-to-pay (WTP) thresholds of 10000 and 50000 USD/LY were 63.5% and 92.4%, respectively. Using commonly accepted WTP thresholds, VATE was more cost-effective than OE for patients with esophageal cancer.
胸腔镜辅助食管切除术（VATE）的临床获益是否超过其增加的成本仍未得到解答。在这里，我们在真实环境中分析了 VATE 与开放性食管切除术（OE）的成本效益。我们使用了 2008 年至 2015 年台湾健康保险索赔数据，确定了 3271 名接受经胸食管切除术的食管癌患者。通过考虑九个混杂变量，我们构建了 VATE 或 OE 患者的 1:1 倾向评分匹配样本（每组 629 例）。分析了术后 3 年内的直接成本和生存率。两组在 R0 切除率、住院时间以及 30 天和 90 天死亡率和非计划性再入院率方面没有显著差异。然而，VATE 组的解剖淋巴结数量较高（中位数：24 对 18，P<0.001）。虽然 VATE 的住院费用较高（中位数为 12331 美元对 10730 美元，P<0.001），但随着时间的推移，成本差异会减少。VATE 的人均累计成本在出院后 14 个月低于 OE。VATE 治疗患者的总体生存率（OS）更为有利（3 年 OS：47%对 41%；预期寿命：4.04 生命年[LY]对 3.30 LY）。成本效益平面显示，只有 0.3%的 VATE 手术比 OE 更昂贵且效果更差。VATE 在愿意支付（WTP）阈值为 10000 美元和 50000 美元/LY 的情况下具有成本效益的概率分别为 63.5%和 92.4%。使用常见的 WTP 阈值，VATE 对食管癌患者更具成本效益。
