Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China.
Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
BMC Cancer. 2021 Feb 2;21(1):107. doi: 10.1186/s12885-021-07840-6.
Both breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients' quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aims to assess the economic impact and long-term cost-effectiveness of different surgical treatments for early breast cancer. The surgical approaches are including mastectomy (MAST), breast-conserving therapy (BCT), and mastectomy with reconstruction (MAST+RECON).
Based on demographic data, disease-related information and other treatments, we applied propensity score matching (PSM) to perform 1: 1 matching among patients who underwent these three types of surgery in the tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER).
After PSM, there were 205 cases in each group. In the matched data set, the distribution of covariates was fully balanced. The total cost of MAST, MAST+RECON and BCT was $37,392.84, $70,556.03 and $82,330.97, respectively. The quality-adjusted life year (QALYs) were 17.11, 18.40 and 20.20, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $25,707.90/QALY and $14,543.08/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis.
We believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.
保乳手术和乳房重建手术在中国都不太受欢迎，尽管它们可以提高患者的生活质量。主要原因来自经济方面。目前还没有针对早期乳腺癌不同手术治疗方案的经济评估。我们的研究旨在评估早期乳腺癌不同手术治疗的经济影响和长期成本效益。手术方法包括乳房切除术（MAST）、保乳疗法（BCT）和乳房切除术加重建（MAST+RECON）。
基于人口统计学数据、疾病相关信息和其他治疗方法，我们在 2011 年至 2017 年期间在三级学术医疗中心对接受这三种手术的患者应用倾向评分匹配（PSM）进行 1:1 匹配，以获得组间协变量的平衡样本。建立了一个马尔可夫模型。临床数据和成本数据来自病历。健康效用值来自临床调查。通过增量成本效益比（ICER）比较策略。
PSM 后，每组各有 205 例病例。在匹配数据集，协变量的分布完全平衡。MAST、MAST+RECON 和 BCT 的总费用分别为 37392.84 美元、70556.03 美元和 82330.97 美元。质量调整生命年（QALYs）分别为 17.11、18.40 和 20.20。与 MAST 相比，MAST+RECON 和 BCT 的增量成本效益比（ICER）分别为 25707.90 美元/QALY 和 14543.08 美元/QALY。BCT 与 MAST 的 ICER 低于 27931.04 美元的阈值。蒙特卡罗模拟和敏感性分析证实了结果的可靠性和稳定性。
我们认为，在中国资源有限的情况下，在比较了三种手术方法后，BCT 是更具成本效益的首选方案。
