微创部分肾切除术与经皮冷冻消融术治疗 cT1a 期肾癌的成本效果分析。
Cost-effectiveness of minimally invasive partial nephrectomy and percutaneous cryoablation for cT1a renal cell carcinoma.
机构信息
Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
出版信息
Eur Radiol. 2023 Mar;33(3):1801-1811. doi: 10.1007/s00330-022-09211-6. Epub 2022 Nov 4.
BACKGROUND
There is growing evidence that partial nephrectomy (PN) and percutaneous cryoablation (PCA) yield comparable outcomes for patients with cT1a renal cell carcinoma (RCC), although the cost-effectiveness of both treatments still needs to be assessed.
PURPOSE
To perform a cost-effectiveness analysis of PN and PCA for patients with cT1a RCC.
MATERIALS AND METHODS
A decision analysis was created over a 5-year span from a healthcare payer's perspective computing expected costs and outcomes of PN and PCA in terms of quality-adjusted life-years (QALYs) and incremental cost-effectiveness (ICER). After each treatment, the following states were modelled using data from the recent literature: procedural complications, no evidence of disease (NED), local recurrence, metastases, and death from RCC- or non-RCC-related causes. Probabilistic and deterministic sensitivity analyses were performed.
RESULTS
PCA and PN yielded health benefits of 3.68 QALY and 3.67 QALY. Overall expected costs were $20,491 and $26,478 for PCA and PN. On probabilistic sensitivity analysis, PCA was more cost-effective than PN in 84.78% of Monte Carlo simulations. PCA was more cost-effective until its complication risk was at least 38% higher than PN. PCA was more cost-effective than PN when (i) PCAs annual local recurrence risk was < 3.5% higher than that of PN in absolute values; (ii) PCAs annual metastatic risk was < 1.0% higher than that of PN; or (iii) PCAs annual cancer-specific mortality risk < 0.65% higher than that of PN. PCA remained cost-effective until its procedural cost is above $13,875.
CONCLUSION
PCA appears to be more cost-effective than PN for the treatment of cT1a RCC, although the currently available evidence is of limited quality. PCA may be the better treatment strategy in the majority of scenarios varying procedural complications, recurrence, metastatic risk, and RCC-mortality in clinically plausible ranges.
KEY POINTS
• For patients with cT1a RCCs, PCA yields a comparable health benefit at lower costs compared to PN, making PCA the dominant and therefore more cost-effective treatment strategy over PN. • PCA was more cost-effective than PN when (i) PCAs annual local recurrence risk was < 3.5% higher than PN in absolute values; (ii) PCAs annual metastatic risk was < 1.0% higher than PN; or (iii) PCAs annual cancer-specific mortality risk < 0.65% higher than PN. • PCA is more cost-effective than PN for the treatment of cT1a RCC, and it remained so in the majority of scenarios varying procedural complications, recurrence, metastatic risk, and RCC mortality.
背景
越来越多的证据表明，部分肾切除术（PN）和经皮冷冻消融术（PCA）在治疗 cT1a 肾细胞癌（RCC）患者方面具有相当的疗效，尽管这两种治疗方法的成本效益仍需评估。
目的
对 cT1a RCC 患者的 PN 和 PCA 进行成本效益分析。
材料与方法
从医疗保健支付者的角度出发，在 5 年内进行决策分析，以计算 PN 和 PCA 在质量调整生命年（QALYs）和增量成本效益（ICER）方面的预期成本和结果。在每种治疗方法之后，使用最近文献中的数据对以下状态进行建模：手术并发症、无疾病证据（NED）、局部复发、转移和由 RCC 或非 RCC 相关原因引起的死亡。进行了概率和确定性敏感性分析。
结果
PCA 和 PN 带来了 3.68 QALY 和 3.67 QALY 的健康获益。总体预期成本分别为 PCA 20491 美元和 PN 26478 美元。在概率敏感性分析中，在蒙特卡罗模拟的 84.78%中，PCA 比 PN 更具成本效益。只要 PCA 的并发症风险比 PN 高至少 38%，PCA 就比 PN 更具成本效益。当以下情况成立时，PCA 比 PN 更具成本效益：（i）PCA 的年度局部复发风险比 PN 高绝对值的 3.5%；（ii）PCA 的年度转移风险比 PN 高 1.0%；或（iii）PCA 的年度癌症特异性死亡率比 PN 高 0.65%。只要 PCA 的程序成本低于 13875 美元，PCA 就具有成本效益。
结论
对于治疗 cT1a RCC，PCA 似乎比 PN 更具成本效益，尽管目前的证据质量有限。在临床合理范围内，在不同的手术并发症、复发、转移风险和 RCC 死亡率情况下，PCA 可能是更好的治疗策略。
关键点
（i）对于 cT1a RCC 患者，PCA 在成本较低的情况下提供了相当的健康益处，使其成为比 PN 更具优势的治疗策略，因此也更具成本效益。（ii）当以下情况成立时，PCA 比 PN 更具成本效益：（a）PCA 的年度局部复发风险比 PN 高绝对值的 3.5%；（b）PCA 的年度转移风险比 PN 高 1.0%；或（c）PCA 的年度癌症特异性死亡率比 PN 高 0.65%。（iii）PCA 治疗 cT1a RCC 的成本效益优于 PN，并且在大多数情况下都是如此，包括手术并发症、复发、转移风险和 RCC 死亡率。
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