Chen M Y, Wen W P, Li J, Liu Y P, Chen M Y, Tang J, Wen Y H
Department of Otorhinolaryngology, Otorhinolaryngology Institute, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Nov 7;57(11):1304-1310. doi: 10.3760/cma.j.cn115330-20211231-00838.
To perform a cost-effectiveness analysis of endoscopic surgery versus intensity-modulated radiotherapy in the treatment of locally recurrent nasopharyngeal carcinoma (rNPC) from a health-economic perspective. From September 30, 2011 to January 16, 2017, a total of 200 patients were enrolled in the First Affiliated Hospital of Sun Yat-sen University, the First People's Hospital of Foshan, and Sun Yat-sen University Cancer Center. These patients were diagnosed as locally rT1-rT3 stage rNPC and were randomly assigned 1︰1 to the endoscopic surgery group (ENPG) and the intensity-modulated radiotherapy group (IMRT). There were 69 males and 31 females in ENPG, aging from 38 to 55 years. There were 72 males and 28 females in IMRT aging from 41 to 54 years. A retrospective cost-effectiveness analysis of the cohort was conducted using a Markov model. For each modality, data on survival and quality-adjusted life year (QALY) were sourced from relevant articles, and cost prices were included regarding treatment. Weibull distribution was used to estimate time-dependent transition probability. Beta-regression was used to convert the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) to utility. The total cost of ENPG was 29 611.88 yuan, and the total cost of IMRT was 110 082.51 yuan. The incremental cost-effectiveness ratio (ICER) of ENPG versus radiotherapy for locally rNPC was -85 555.88 yuan/QALY, which was less than 3 times of Chinese gross domestic product (GDP) per capita. Sensitivity analysis showed that the cost of IMRT had the greatest impact on ICER. ICER was stable within 10% fluctuation of all the parameters. It is economical cost-effective to treat locally rNPC with ENGP versus IMRT.
从卫生经济学角度对内镜手术与调强放疗治疗局部复发性鼻咽癌（rNPC）进行成本效益分析。2011年9月30日至2017年1月16日，中山大学附属第一医院、佛山市第一人民医院和中山大学肿瘤防治中心共纳入200例患者。这些患者被诊断为局部rT1 - rT3期rNPC，并按1︰1随机分为内镜手术组（ENPG）和调强放疗组（IMRT）。ENPG组有男性69例，女性31例，年龄38至55岁。IMRT组有男性72例，女性28例，年龄41至54岁。采用马尔可夫模型对该队列进行回顾性成本效益分析。对于每种治疗方式，生存和质量调整生命年（QALY）数据来自相关文章，并纳入了治疗的成本价格。使用威布尔分布估计时间依赖性转移概率。使用贝塔回归将欧洲癌症研究与治疗组织生活质量问卷核心30（EORTC QLQ - C30）转换为效用值。ENPG组的总成本为29611.88元，IMRT组的总成本为110082.51元。ENPG组与放疗组治疗局部rNPC的增量成本效益比（ICER）为 - 85555.88元/QALY，低于中国人均国内生产总值（GDP）的3倍。敏感性分析表明，IMRT的成本对ICER影响最大。在所有参数10%的波动范围内，ICER稳定。与IMRT相比，采用ENGP治疗局部rNPC具有经济成本效益。
