氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描和腹腔镜检查对局部进展期胃癌分期的影响：前瞻性多中心 PLASTIC 研究中的成本分析。
Impact of FDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study.
机构信息
Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
出版信息
Ann Surg Oncol. 2024 Jun;31(6):4005-4017. doi: 10.1245/s10434-024-15103-4. Epub 2024 Mar 25.
BACKGROUND
Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and staging laparoscopy (SL) in gastric cancer staging.
MATERIALS AND METHODS
In this cost analysis, four staging strategies were modeled in a decision tree: (1) FDG-PET/CT first, then SL, (2) SL only, (3) FDG-PET/CT only, and (4) neither SL nor FDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding FDG-PET/CT and SL to staging advanced gastric cancer (cT3-4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided FDG-PET/CT unit costs. SL unit costs were calculated bottom-up. Gastrectomy-associated costs were collected with hospital claim data until 30 days postoperatively. Uncertainty was assessed in a probabilistic sensitivity analysis (1000 iterations).
RESULTS
FDG-PET/CT costs were €1104 including biopsy/cytology. Bottom-up calculations totaled €1537 per SL. D2-gastrectomy costs were €19,308. Total costs per patient were €18,137 for strategy 1, €17,079 for strategy 2, and €19,805 for strategy 3. If all patients undergo gastrectomy, total costs were €18,959 per patient (strategy 4). Performing SL only reduced costs by €1880 per patient. Adding FDG-PET/CT to SL increased costs by €1058 per patient; IQR €870-1253 in the sensitivity analysis.
CONCLUSIONS
For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine FDG-PET/CT increased costs without substantially reducing unnecessary gastrectomies, and is not recommended due to limited impact with major costs.
TRIAL REGISTRATION
NCT03208621. This trial was registered prospectively on 30-06-2017.
背景
在检测出不可治愈的胃癌后，可以避免不必要的 D2 胃切除术和相关费用，但分期对治疗费用的影响尚不清楚。本研究旨在确定 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）和分期腹腔镜检查（SL）在胃癌分期中的成本影响。
材料和方法
在本成本分析中，在决策树中对以下四种分期策略进行建模：（1）FDG-PET/CT 优先，然后是 SL；（2）仅 SL；（3）仅 FDG-PET/CT；（4）既不进行 SL 也不进行 FDG-PET/CT。成本是根据前瞻性 PLASTIC 研究进行评估的，该研究评估了在 18 家荷兰医院对进展期胃癌（cT3-4 和/或 cN+）进行 FDG-PET/CT 和 SL 分期的方法。荷兰医疗保健管理局提供了 FDG-PET/CT 单位成本。SL 单位成本通过自下而上的计算得出。胃切除术相关费用通过医院索赔数据收集，直到术后 30 天。在概率敏感性分析（1000 次迭代）中评估了不确定性。
结果
FDG-PET/CT 包括活检/细胞学检查的费用为 1104 欧元。SL 的自下而上计算总计为 1537 欧元。D2 胃切除术的费用为 19308 欧元。每位患者的总费用为策略 1 为 18137 欧元，策略 2 为 17079 欧元，策略 3 为 19805 欧元。如果所有患者都接受胃切除术，每位患者的总费用为 18959 欧元（策略 4）。仅进行 SL 可使每位患者的费用减少 1880 欧元。在 SL 的基础上增加 FDG-PET/CT 会使每位患者的费用增加 1058 欧元；在敏感性分析中，IQR 为 870-1253 欧元。
结论
对于进展期胃癌，通过减少不必要的胃切除术，SL 的实施可显著降低成本。相比之下，常规 FDG-PET/CT 增加了成本，而没有显著减少不必要的胃切除术，并且由于影响较小且成本较高，因此不建议使用。
试验注册
NCT03208621。本试验于 2017 年 6 月 30 日前瞻性注册。
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