Ramtohul Toulsie, Vilgrain Valérie, Soubrane Olivier, Bouattour Mohamed, Luciani Alain, Kobeiter Hicham, Mule Sébastien, Tacher Vania, Laurent Alexis, Amaddeo Giuliana, Regnault Hélène, Bulsei Julie, Nault Jean-Charles, Nahon Pierre, Durand-Zaleski Isabelle, Seror Olivier
AP-HP, Health Economics Research Unit, 75004 Paris, France.
AP-HP, Department of Radiology, Jean Verdier Hospital, 93140 Bondy, France.
Cancers (Basel). 2022 May 26;14(11):2634. doi: 10.3390/cancers14112634.
To evaluate the cost-effectiveness of the extended use of ablation for the treatment of hepatocellular carcinoma (HCC) with cirrhosis in an expert ablation center when compared to the non-extended use of ablation in equivalent tertiary care centers.
Consecutive cirrhotic patients with non-metastatic HCC, no prior treatment, and referred to three tertiary care centers between 2012 and 2016 were retrospectively identified. The Bondy group, including all of the patients treated at Jean Verdier Hospital, where the extended use of ablation is routinely performed, was compared to the standard of care (SOC) group, including all of the patients treated at the Beaujon and Mondor Hospitals, using propensity score matching. A cost-effectiveness analysis was carried out from the perspective of French health insurance using a Markov model on a lifetime horizon.
532 patients were matched. The Bondy group led to incremental discounted lifetime effects of 0.8 life-years gained (LYG) (95% confidence interval: 0.4, 1.3) and a decrease in lifetime costs of EUR 7288 (USD 8016) (95% confidence interval: EUR 5730 [USD 6303], EUR 10,620 [USD 11,682]) per patient, compared with the SOC group, resulting in a dominant mean incremental cost-effectiveness ratio (ICER). A compliance with the Barcelona Clinic Liver Classification (BCLC) guidelines for earlier stage contributed to the greater part of the ICER.
The extended use of ablation in cirrhotic patients with HCC was more effective and less expensive than the non-extended use of the ablation strategy.
在一家专业消融中心，评估与同等三级医疗中心非扩大消融治疗相比，扩大消融治疗肝硬化肝细胞癌（HCC）的成本效益。
回顾性确定2012年至2016年间连续收治的无转移的HCC肝硬化患者，这些患者未曾接受过治疗，且被转诊至三家三级医疗中心。将在让·韦迪耶医院接受治疗的所有患者组成的邦迪组（该医院常规进行扩大消融治疗）与在博若莱医院和蒙多医院接受治疗的所有患者组成的标准治疗（SOC）组进行倾向得分匹配。从法国医疗保险的角度，使用马尔可夫模型在终身范围内进行成本效益分析。
匹配了532例患者。与SOC组相比，邦迪组导致每位患者的增量贴现终身效应为获得0.8个生命年（LYG）（95 %置信区间：0.4，1.3），终身成本降低7288欧元（8016美元）（95 %置信区间：5730欧元[6303美元]，10620欧元[11682美元]），从而产生了占优的平均增量成本效益比（ICER）。符合巴塞罗那临床肝癌分类（BCLC）指南的早期阶段对ICER的贡献更大。
在肝硬化HCC患者中扩大消融治疗比非扩大消融治疗策略更有效且成本更低。
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