School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China.
School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China.
J Cancer Res Clin Oncol. 2023 Dec;149(18):16705-16715. doi: 10.1007/s00432-023-05406-6. Epub 2023 Sep 19.
Pancreatic cancer is a digestive malignancy with dismal prognosis. The advent of Heidelberg TRIANGLE dissection technique brings a turning point to improve the chance of survival. Our study aimed to evaluated the cost-effectiveness of open pancreaticoduodenectomy (OPD) versus OPD combined with TRIANGLE operation (OPD-TRIANGLE) for patients with pancreatic cancer from the perspective of healthcare system in China.
Two hundred forty-six patients with pancreatic cancer who underwent OPD or OPD-TRIANGLE from January to September 2022 were enrolled in this study. We performed a decision tree model to assess clinical and economic implications of different surgical strategies. Estimation of health utilities was based on published literature, while costs were acquired from the hospitals, clinical expert consultations, and other local charge. The incremental cost-effectiveness ratio (ICER) was regarded as the primary outcome. Uncertainty of the findings was addressed via sensitivity analyses and scenario analyses.
The results indicated that OPD-TRIANGLE group yielded additional 0.0402 QALYs at an incremental cost of US$1501.83 compared with OPD group, and the corresponding ICER was US$37,358.96 per QALY. The probabilities of OPD-TRIANGLE as the prior option were 52.8% at the WTP threshold of 60,000 US$/QALY. The main factors lined with costs incorporating total medical costs and operation-related costs. With 5-20% price reduction of OPD-TRIANGLE, the outcomes were also economically attractive.
The findings of this population-based study suggested that OPD-TRIANGLE was likely to be cost-effective for patients with pancreatic cancer when compared against OPD. Further in-depth studies should be conducted to provide more comprehensive evidence.
胰腺癌是一种预后极差的消化系统恶性肿瘤。海德堡 TRIANGLE 解剖技术的出现为提高生存机会带来了转机。我们的研究旨在从中国医疗保健系统的角度评估开放式胰十二指肠切除术（OPD）与 OPD 联合 TRIANGLE 手术（OPD-TRIANGLE）治疗胰腺癌患者的成本效益。
本研究纳入了 2022 年 1 月至 9 月期间接受 OPD 或 OPD-TRIANGLE 手术的 246 例胰腺癌患者。我们使用决策树模型评估了不同手术策略的临床和经济影响。健康效用的估计基于已发表的文献，而成本则来自医院、临床专家咨询和其他当地收费。增量成本效益比（ICER）被视为主要结果。通过敏感性分析和情景分析来解决研究结果的不确定性。
结果表明，与 OPD 组相比，OPD-TRIANGLE 组在增加 1501.83 美元的增量成本下获得了额外的 0.0402 个 QALY，相应的 ICER 为每 QALY 37358.96 美元。在 60000 美元/QALY 的 WTP 阈值下，OPD-TRIANGLE 作为首选方案的概率为 52.8%。主要因素与总成本和手术相关成本有关。如果 OPD-TRIANGLE 的价格降低 5-20%，其结果也具有经济吸引力。
这项基于人群的研究结果表明，与 OPD 相比，OPD-TRIANGLE 可能对胰腺癌患者具有成本效益。需要进一步开展深入研究，以提供更全面的证据。
