Division of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Davis, Sacramento, CA.
Division of Surgical Oncology, Department of Surgery, University of Toronto, Ontario, Canada.
J Am Coll Surg. 2021 Jul;233(1):90-98. doi: 10.1016/j.jamcollsurg.2021.02.014. Epub 2021 Mar 22.
Volume of operative cases may be an important factor associated with improved survival for early-stage pancreatic cancer. Most high-volume pancreatic centers are also academic institutions, which have been associated with additional healthcare costs. We hypothesized that at high-volume centers, the value of the extra survival outweighs the extra cost.
This retrospective cohort study used data from the California Cancer Registry linked to the Office of Statewide Health Planning and Development database from January 1, 2004 through December 31, 2012. Stage I-II pancreatic cancer patients who underwent resection were included. Multivariable analyses estimated overall survival and 30-day costs at low- vs high-volume pancreatic surgery centers. The incremental cost-effectiveness ratio (ICER) and incremental net benefit (INB) were estimated, and statistical uncertainty was characterized using net benefit regression.
Of 2,786 patients, 46.5% were treated at high-volume centers and 53.5% at low-volume centers. There was a 0.45-year (5.4 months) survival benefit (95% CI 0.21-0.69) and a $7,884 extra cost associated with receiving surgery at high-volume centers (95% CI $4,074-$11,694). The ICER was $17,529 for an additional year of survival (95% CI $7,997-$40,616). For decision-makers willing to pay more than $20,000 for an additional year of life, high-volume centers appear cost-effective.
Although healthcare costs were greater at high-volume centers, patients undergoing pancreatic surgery at high-volume centers experienced a survival benefit (5.4 months). The extra cost of $17,529 per additional year is quite modest for improved survival and is economically attractive by many oncology standards.
手术量可能是与早期胰腺癌患者生存率提高相关的一个重要因素。大多数大容量胰腺中心也是学术机构，这与额外的医疗保健成本有关。我们假设在大容量中心，额外的生存价值超过额外的成本。
本回顾性队列研究使用了加利福尼亚癌症登记处的数据，并与 2004 年 1 月 1 日至 2012 年 12 月 31 日期间全州卫生规划和发展办公室数据库相关联。纳入接受切除术的 I 期- II 期胰腺癌患者。多变量分析估计低容量与高容量胰腺手术中心的总生存率和 30 天成本。使用净效益回归估计增量成本效益比（ICER）和增量净效益（INB），并描述统计不确定性。
在 2786 名患者中，46.5%在大容量中心治疗，53.5%在小容量中心治疗。在大容量中心接受手术的患者有 0.45 年（5.4 个月）的生存获益（95%CI 0.21-0.69），额外花费 7884 美元（95%CI 4074 美元至 11694 美元）。额外 1 年的生存成本为 17529 美元（95%CI 7997 美元至 40616 美元）。对于愿意为额外 1 年的生命支付超过 20000 美元的决策者，大容量中心似乎具有成本效益。
尽管大容量中心的医疗保健成本更高，但在大容量中心接受胰腺手术的患者生存获益（5.4 个月）。额外的 17529 美元成本对于提高生存率来说是相当适度的，并且按照许多肿瘤学标准，这是有吸引力的。
