Daroudi Rajabali, Nahvijou Azin, Arab Mohammad, Faramarzi Ahmad, Kalaghchi Bita, Sari Ali Akbari, Javan-Noughabi Javad
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
Cost Eff Resour Alloc. 2022 Apr 2;20(1):16. doi: 10.1186/s12962-022-00352-5.
Esophageal cancer causes considerable costs for health systems. Appropriate treatment options for patients with esophageal squamous cell carcinoma (ESCC) can reduce medical costs and provide more improved outcomes for health systems and patients. This study evaluates the cost-effectiveness of treatment interventions for patients with ESCC according to the Iranian health system.
A five-state Markov model with a 15-year time horizon was performed to evaluate the cost-effectiveness of treatment interventions based on stage for ESCC patients. Costs ($US 2021) and outcomes were calculated from the Iranian health system, with a discount rate of 3%. One-way sensitivity analyses were performed to assess the potential effects of uncertain variables on the model results.
In stage I, the Endoscopic Mucosal Resection (EMR) treatment yielded the lowest total costs and highest total QALY for a total of $1473 per QALY, making it the dominant strategy compared with esophagectomy and EMR followed by ablation. In stages II and III, chemoradiotherapy (CRT) followed by surgery dominated esophagectomy. CRT followed by surgery was also cost-effective with an incremental cost-effectiveness ratio (ICER) of $2172.8 per QALY compared to CRT.
From the Iranian health system's perspective, EMR was the dominant strategy versus esophagectomy and EMR followed by ablation for ESCC patients in stage I. The CRT followed by surgery was a cost-effective intervention compared to CRT and esophagectomy in stages II and III.
食管癌给卫生系统带来了相当大的成本。食管鳞状细胞癌（ESCC）患者的适当治疗方案可以降低医疗成本，并为卫生系统和患者带来更好的治疗效果。本研究根据伊朗卫生系统评估了ESCC患者治疗干预措施的成本效益。
采用一个具有15年时间跨度的五状态马尔可夫模型，以评估基于分期的ESCC患者治疗干预措施的成本效益。成本（2021年美元）和结果是根据伊朗卫生系统计算得出的，贴现率为3%。进行单向敏感性分析，以评估不确定变量对模型结果的潜在影响。
在I期，内镜黏膜切除术（EMR）治疗的总成本最低，总质量调整生命年（QALY）最高，每QALY为1473美元，与食管切除术和EMR后消融相比，这使其成为主导策略。在II期和III期，化疗放疗（CRT）后手术优于食管切除术。与CRT相比，CRT后手术的成本效益也很高，增量成本效益比（ICER）为每QALY 2172.8美元。
从伊朗卫生系统的角度来看，对于I期ESCC患者，EMR与食管切除术以及EMR后消融相比是主导策略。在II期和III期，与CRT和食管切除术相比，CRT后手术是一种具有成本效益的干预措施。
