从医疗保险角度看转移性前列腺癌中附加局部前列腺放射治疗的成本效益分析。

Cost-effectiveness analysis of additional local prostate radio therapy in metastatic prostate cancer from a medicare perspective.

机构信息

Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.

Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.

出版信息

Radiat Oncol. 2024 Nov 21;19(1):167. doi: 10.1186/s13014-024-02544-0.

DOI:10.1186/s13014-024-02544-0

PMID:39574140

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11580356/

Abstract

BACKGROUND

Metastatic prostate cancer remains a therapeutic challenge. Based on data of the STAMPEDE trial, patients with a low metastatic burden showed prolonged failure-free and overall survival when treated with prostate radio therapy (RT) in addition to standard of care (SOC). The objective of this study was to determine the cost-effectiveness of additional prostate RT compared to SOC alone for following subgroups: non-regional lymph node (NRLN) metastases, up to three bone metastases and four or more bone metastases.

METHODS

A partitioned survival model was implemented with clinical data from STAMPEDE trial. Analyses were performed from a United States healthcare system perspective. Costs for treatment and adverse events were derived from Medicare coverage. Utilities for health states were derived from public databases and literature. Outcome measurements included incremental costs, effectiveness, and cost-effectiveness ratio. The willingness-to-pay threshold was set to USD 100,000 per quality-adjusted life year (QALY).

RESULTS

Additional RT led to 0.92 incremental QALYs with increased costs of USD 26,098 with an incremental cost-effectiveness ratio (ICER) of USD 28,452/QALY for patients with only NRLN metastases and 3.83 incremental QALYs with increased costs of USD 153,490 with an ICER of USD 40,032/QALY for patients with up to three bone metastases. Sensitivity analysis showed robustness of the model regarding various parameters. In probabilistic sensitivity analysis using Monte Carlo simulation with 10,000 iterations, additional RT was found as the cost-effective strategy in over 96% for both subgroups iterations at a willingness-to-pay threshold of USD 100,000/QALYs.

CONCLUSIONS

Additional RT is cost-effective in patients with only NRLN metastases and up to three metastases compared to SOC.

摘要

背景

转移性前列腺癌仍然是一个治疗挑战。基于 STAMPEDE 试验的数据，在标准治疗（SOC）基础上加用前列腺放射治疗（RT）的患者，转移负担较低时，无失败生存和总生存时间延长。本研究的目的是确定与 SOC 相比，加用前列腺 RT 治疗以下亚组患者的成本效益：非区域淋巴结（NRLN）转移、最多 3 处骨转移和 4 处或更多骨转移。

方法

采用 STAMPEDE 试验的临床数据，建立分割生存模型。分析从美国医疗保健系统的角度进行。治疗和不良反应的成本来自医疗保险覆盖范围。健康状态的效用来自公共数据库和文献。结局测量包括增量成本、效果和增量成本效益比。意愿支付阈值设定为每质量调整生命年（QALY）10 万美元。

结果

仅 NRLN 转移患者，加用 RT 可获得 0.92 个增量 QALY，增加成本为 26098 美元，增量成本效益比（ICER）为 28452 美元/QALY；最多 3 处骨转移患者，加用 RT 可获得 3.83 个增量 QALY，增加成本为 153490 美元，ICER 为 40032 美元/QALY。敏感性分析显示，该模型对各种参数具有稳健性。在使用蒙特卡罗模拟的 10000 次迭代的概率敏感性分析中，在意愿支付阈值为 10 万美元/QALY 时，对于这两个亚组，加用 RT 都是具有成本效益的策略，超过 96%的迭代情况如此。