Katanyoo Kanyarat, Chaikledkaew Usa, Thavorncharoensap Montarat, Riewpaiboon Arthorn
Social, Economic and Administrative Pharmacy (SEAP) Graduate Program, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Department of Radiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Clinicoecon Outcomes Res. 2021 Nov 22;13:943-955. doi: 10.2147/CEOR.S327698. eCollection 2021.
We aimed to determine the cost-effectiveness of diagnostic tests, ie, computed tomography (CT), magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET⁄CT) for para-aortic lymph node detection (PALND), in locally advanced cervical cancer (LACC) patients (stages IB3-IVA) with or without laparoscopic lymphadenectomy (LL) compared with no investigation (NoIx) based on provider and societal perspectives during 5 years.
Hybrid decision tree and Markov models were conducted to compare the cost and utility of six interventions including: 1) CT without LL, 2) CT with LL, 3) MRI without LL, 4) MRI with LL, 5) PET/CT without LL, and 6) PET/CT with LL compared with NoIx. All clinical parameters were obtained from published studies. Costs were presented in year 2019 values. Direct medical costs were retrieved from hospital database, while direct non-medical costs and utility were collected from interviewing 194 LACC patients during June to December 2019. One-way and probabilistic sensitivity analysis were used to investigate parameter uncertainties.
Total costs of NoIx were $8026 and $11,444 from provider and societal perspectives, respectively, and quality-adjusted life year (QALY) was 3.70. NoIx was more effective and less costly. When six strategies were compared with NoIx, more additional costs were shown with $1835, $1735, $2022, $1987, $4002, and $4176 for CT without LL, CT with LL, MRI without LL, MRI with LL, PET/CT without LL, and PET/CT with LL, whereas QALYs were decreased with 0.07, 0.08, 0.07, 0.08, 0.05, and 0.07, respectively. Sensitivity analyses strengthened the benefit of NoIx. The most significant parameter was treatment outcomes of patients with PALN metastasis.
NoIx or receiving basic clinical staging was a dominant option when compared with CT, MRI, and PET/CT for PALND before providing the treatment for LACC patients.
我们旨在确定在5年期间，从医疗服务提供者和社会角度出发，对于局部晚期宫颈癌（LACC，IB3-IVA期）患者，无论有无腹腔镜淋巴结清扫术（LL），诊断性检查即计算机断层扫描（CT）、磁共振成像（MRI）和氟-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）用于腹主动脉旁淋巴结检测（PALND）的成本效益，与不进行检查（NoIx）相比较。
采用混合决策树和马尔可夫模型来比较六种干预措施的成本和效用，这六种干预措施包括：1）不进行LL的CT；2）进行LL的CT；3）不进行LL的MRI；4）进行LL的MRI；5）不进行LL的PET/CT；6）进行LL的PET/CT，与NoIx进行比较。所有临床参数均来自已发表的研究。成本以2019年的价值呈现。直接医疗成本从医院数据库中获取，而直接非医疗成本和效用则通过在2019年6月至12月期间对194例LACC患者进行访谈收集。采用单向和概率敏感性分析来研究参数的不确定性。
从医疗服务提供者和社会角度来看，NoIx的总成本分别为8026美元和11444美元，质量调整生命年（QALY）为3.70。NoIx更有效且成本更低。当将六种策略与NoIx进行比较时，不进行LL的CT、进行LL的CT、不进行LL的MRI、进行LL的MRI、不进行LL的PET/CT和进行LL的PET/CT分别显示出额外成本为1835美元、1735美元、2022美元、1987美元、4002美元和4176美元，而QALY分别降低了0.07、0.08、0.07、0.08、0.05和0.07。敏感性分析强化了NoIx的益处。最显著的参数是PALN转移患者的治疗结果。
在为LACC患者提供治疗之前，与CT、MRI和PET/CT用于PALND相比，NoIx或接受基本临床分期是一个占优选择。
