Rui Mingjun, Wang Yingcheng
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Head Neck. 2025 Feb;47(2):529-537. doi: 10.1002/hed.27942. Epub 2024 Sep 23.
Nasopharyngeal carcinoma (NPC) is a significant health concern in southern China, like Guangdong and Hong Kong. This study aims to predict the effectiveness and cost-effectiveness of two prevalent NPC treatments, intensity-modulated radiotherapy (IMRT) and endoscopic nasopharyngectomy (ENPG).
A microsimulation model was developed to project the long-term outcomes of IMRT and ENPG, simulating 5000 patients with hypothetical locally recurrent NPC for each treatment option. The tumors of patients confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Analyses were performed from the healthcare system perspectives of Mainland China and the healthcare provider perspective of Hong Kong, with input parameters sourced from the existing literature and databases. The robustness of findings was evaluated through one-way and probabilistic sensitivity analyses.
For DFS, ENPG showed a 29% reduction in risk with an HR of 0.71 (95% CI: 0.64-0.77) compared to IMRT. ENPG demonstrated a significant survival benefit in OS with an HR of 0.59 (95% CI: 0.54-0.65), equating to a 41% reduction in mortality risk. In Hong Kong, IMRT and ENPG yielded QALY gains of 4.59 and 6.29, respectively, with ENPG exhibiting an incremental cost-effectiveness ratio (ICUR) of USD 13 057 per QALY. For Mainland China, ENPG denominated the IMRT and the ICUR was USD -1450 QALY. Probabilistic sensitivity analysis showed a 100% probability of ENPG being cost-effective at the willingness-to-pay thresholds of USD 130 490 per QALY in Hong Kong and USD 12 741 per QALY in Mainland China.
The analysis confirms that ENPG is more effective and cost-effective than IMRT for treating recurrent NPC in both Hong Kong and Mainland China.
鼻咽癌（NPC）是中国南方（如广东和香港）一个重大的健康问题。本研究旨在预测两种常见的鼻咽癌治疗方法——调强放射治疗（IMRT）和内镜下鼻咽癌切除术（ENPG）的有效性和成本效益。
开发了一个微观模拟模型来预测IMRT和ENPG的长期结果，为每种治疗方案模拟5000例假设为局部复发性鼻咽癌的患者。患者的肿瘤局限于鼻咽腔、后鼻孔或鼻中隔、咽旁间隙浅层或蝶窦底壁。从中国大陆的医疗保健系统角度和香港的医疗服务提供者角度进行分析，输入参数来自现有文献和数据库。通过单因素和概率敏感性分析评估研究结果的稳健性。
对于无病生存期（DFS），与IMRT相比，ENPG的风险降低了29%，风险比（HR）为0.71（95%置信区间：0.64-0.77）。ENPG在总生存期（OS）方面显示出显著的生存获益，HR为0.59（95%置信区间：0.54-0.65），相当于死亡风险降低41%。在香港，IMRT和ENPG分别产生了4.59和6.29个质量调整生命年（QALY）的增益，ENPG的增量成本效益比（ICUR）为每QALY 13057美元。对于中国大陆，ENPG优于IMRT，ICUR为每QALY -1450美元。概率敏感性分析显示，在香港每QALY支付意愿阈值为130490美元和中国大陆每QALY支付意愿阈值为12741美元时，ENPG具有成本效益的概率为100%。
分析证实，在香港和中国大陆，ENPG在治疗复发性鼻咽癌方面比IMRT更有效且更具成本效益。
