Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
Department of Obstetrics and Gynecology, Toyohashi Municipal Hospital, Aichi, Japan.
J Gynecol Oncol. 2024 Sep;35(5):e61. doi: 10.3802/jgo.2024.35.e61. Epub 2024 Feb 26.
Hospital treatment volume affects survival in patients with endometrial cancer; notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan.
A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and high-volume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses.
A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of ¥5,000,000 with a maximum of ¥3,777,830/4.28 QALY for the high- and intermediate-risk group, and ¥2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or low-volume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and low-risk groups, respectively.
Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer.
医院治疗量影响子宫内膜癌患者的生存率；值得注意的是，在高容量中心进行初始治疗可改善生存结局。本研究评估了日本子宫内膜癌患者的医院治疗量对成本效益和生存结局的影响。
使用以下变量及其对成本效益的影响评估决策分析模型：1）医院治疗量（低、中、高容量中心）和 2）基于病理发现的术后复发危险因素（高、中风险或低风险）。数据来自日本妇产科协会数据库、系统文献检索和日本诊断程序组合数据库。质量调整生命年（QALY）用作衡量疗效的指标。该模型从公共医疗保健角度构建，使用敏感性分析评估不确定性的影响。
基础案例分析表明，高容量中心的增量成本效益比低于 500 万日元的意愿支付（WTP）阈值，高风险和中风险组的最高增量成本效益比为 3777830 日元/4.28 QALY，低风险组为 2316695 日元/4.57 QALY。与中或低容量中心相比，高容量中心的治疗在两种策略中均显示出更好的效率和成本效益。敏感性分析表明，模型结果对输入值的变化具有稳健性。在 WTP 阈值下，对于高风险和中风险组以及低风险组，高容量中心的治疗在至少 73.6%和 78.2%的迭代中仍然具有成本效益。
对于指导子宫内膜癌患者的治疗集中化，高容量中心的治疗是最具成本效益的策略。
