Pham Phu Duy, Muchadeyi Muchandifunga Trust, Lindholm Lars
Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, Sweden.
Cost Eff Resour Alloc. 2023 Nov 10;21(1):86. doi: 10.1186/s12962-023-00495-z.
Breast cancer represents the most prevalent cancer among Swedish women. Although considerable research has investigated the cost-effectiveness of emerging innovative medical treatments for breast cancer, studies addressing existing surgical procedures remain scant. Therefore, this study aimed to evaluate the cost-effectiveness of three surgical procedures for in situ breast cancer treatment in Sweden: mastectomy, lumpectomy without irradiation, and lumpectomy with irradiation.
A six-state Markov model with a 30-year time horizon was used to compare the cost-effectiveness of the three alternatives. Transition probabilities were based on a targeted literature review focusing on available evidence in Sweden and comparable contexts. Costs were estimated from both healthcare and societal perspectives, using patient data from the Swedish National Cancer Registry in 2020 (Cancerregistret). Health outcomes were quantified in terms of quality-adjusted life years (QALYs). Cost and health outcomes were then summarised into an incremental cost-effectiveness ratio (ICER) between competing strategies. A probabilistic sensitivity analysis (PSA) was conducted to address the uncertainties in the input parameters.
The results showed that compared to lumpectomy without irradiation, lumpectomy with irradiation yielded a "moderate" ICER per QALY gained of 402,994 Swedish Krona (SEK) from a healthcare perspective and a "high" ICER of 575,833 SEK from a societal perspective. Mastectomy proved to be the costliest and least effective of the three alternatives over a 30-year period. The PSA results further substantiated these findings.
Our study demonstrated that lumpectomy with irradiation is "moderately" cost-effective compared with lumpectomy without irradiation. Nevertheless, extending this study by conducting a comprehensive budget impact analysis to account for the prevalence of in situ breast cancer in Sweden is prudent. These results imply that a costlier and less effective mastectomy should only be considered when lumpectomy options are infeasible. Further studies are needed to obtain more reliable parameters relevant to Sweden and to increase the consistency of the findings.
乳腺癌是瑞典女性中最常见的癌症。尽管已有大量研究探讨了新型创新乳腺癌治疗方法的成本效益，但针对现有外科手术的研究仍然很少。因此，本研究旨在评估瑞典原位乳腺癌治疗的三种外科手术的成本效益：乳房切除术、无放疗的肿块切除术和有放疗的肿块切除术。
采用一个具有30年时间跨度的六状态马尔可夫模型来比较这三种方案的成本效益。转移概率基于有针对性的文献综述，重点关注瑞典及类似背景下的现有证据。从医疗保健和社会角度估算成本，使用2020年瑞典国家癌症登记处（Cancerregistret）的患者数据。健康结果以质量调整生命年（QALY）进行量化。然后将成本和健康结果汇总为竞争策略之间的增量成本效益比（ICER）。进行概率敏感性分析（PSA）以解决输入参数中的不确定性。
结果表明，与无放疗的肿块切除术相比，有放疗的肿块切除术从医疗保健角度获得每QALY的“中等”ICER为402,994瑞典克朗（SEK），从社会角度获得的“高”ICER为575,833瑞典克朗。在30年期间，乳房切除术被证明是这三种方案中成本最高且效果最差的。PSA结果进一步证实了这些发现。
我们的研究表明，与无放疗的肿块切除术相比，有放疗的肿块切除术具有“中等”成本效益。然而，通过进行全面的预算影响分析来考虑瑞典原位乳腺癌的患病率来扩展本研究是谨慎的。这些结果意味着，只有在肿块切除方案不可行时，才应考虑成本更高且效果更差的乳房切除术。需要进一步研究以获得与瑞典相关的更可靠参数，并提高研究结果的一致性。
