State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
Breast. 2021 Aug;58:72-79. doi: 10.1016/j.breast.2021.04.002. Epub 2021 Apr 19.
The phase 3 NCT00793962 trial demonstrated that postmastectomy hypofractionated radiation therapy (HFRT) was noninferior to conventional fractionated radiation therapy (CFRT) in patients with high-risk breast cancer. This study assessed the cost-effectiveness of postmastectomy HFRT vs CFRT based on the NCT00793962 trial.
A Markov model was adopted to synthesize the medical costs and health benefits of patients with high-risk breast cancer based on data from the NCT00793962 trial. Main outcomes were discounted lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). We employed a time-dependent horizon from Chinese, French and USA payer perspectives. Model robustness was evaluated with one-way and probabilistic sensitivity analyses.
Patients receiving CFRT versus HFRT gained an incremental 0.0163 QALYs, 0.0118 QALYs and 0.0028 QALYs; meanwhile an incremental cost of $2351.92, $4978.34 and $8812.70 from Chinese, French and USA payer perspectives, respectively. Thus CFRT versus HFRT yielded an ICER of $144,281.47, $420,636.10 and $3,187,955.76 per QALY from Chinese, French and USA payer perspectives, respectively. HFRT could maintain a trend of >50% probabilities of cost-effectiveness below a willingness-to-pay (WTP) of $178,882.00 in China, while HFRT was dominant relative to CFRT, regardless of the WTP values in France and the USA. Sensitivity analyses indicated that the ICERs were most sensitive to the parameters of overall survival after radiotherapy.
Postmastectomy HFRT could be used as a cost-effective substitute for CFRT in patients with high-risk breast cancer and should be considered in appropriately selected patients.
NCT00793962 三期临床试验表明，对于高危乳腺癌患者，乳房切除术后的亚分次放疗（HFRT）并不逊于常规分次放疗（CFRT）。本研究基于 NCT00793962 试验评估了乳房切除术后 HFRT 与 CFRT 的成本效益。
采用 Markov 模型，根据 NCT00793962 试验的数据，综合高危乳腺癌患者的医疗成本和健康效益。主要结果是贴现终身成本、质量调整生命年（QALYs）和增量成本效益比（ICER）。我们从中国、法国和美国支付者的角度采用了时间依赖性的时间范围。采用单因素和概率敏感性分析评估模型的稳健性。
接受 CFRT 与 HFRT 的患者分别获得了 0.0163、0.0118 和 0.0028 个 QALY 的增量，分别产生了 2351.92、4978.34 和 8812.70 美元的增量成本，从中国、法国和美国支付者的角度来看。因此，CFRT 与 HFRT 在中国的每 QALY 的 ICER 分别为 144281.47、420636.10 和 3187955.76 美元，在法国和美国的每 QALY 的 ICER 分别为 178882.00 美元。HFRT 在 WTP 低于 178882.00 美元时，能够保持成本效益大于 50%的概率趋势，而 HFRT 相对于 CFRT 是主导的，无论法国和美国的 WTP 值如何。敏感性分析表明，ICER 对放疗后总生存的参数最为敏感。
对于高危乳腺癌患者，乳房切除术后 HFRT 可以作为 CFRT 的一种具有成本效益的替代方法，应在适当选择的患者中考虑。
