Lai Min, Li YanTing, Lan Ning, Yuan Wenzhen
The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Department of Radiation Oncology, First Affiliated Hospital of Xi 'an Jiaotong University, Xian, China.
Sci Rep. 2025 Feb 25;15(1):6714. doi: 10.1038/s41598-025-91003-1.
Locally advanced gastric cancer (LAGC) poses a significant surgical challenge. While laparoscopic gastrectomy (LG) offers potential advantages, its cost-effectiveness relative to open gastrectomy (OG) in China remains uncertain. To compare the cost-effectiveness of LG and OG for LAGC in China. A Markov model compared the cost-effectiveness of LG and OG for LAGC. Probabilities and utilities were derived from published literature. Direct medical costs were obtained from the First Hospital of Lanzhou University. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality-adjusted life-year (QALY) gained, using a willingness-to-pay threshold of ¥268,074/QALY. Sensitivity analyses assessed model robustness. Across 1-, 3-, and 5-year time horizons, OG had lower total costs and greater effectiveness than LG for LAGC. At 5 years, OG had a total cost of ¥128,259 and 7.20 QALYs versus LG's ¥136,668 and 7.18 QALYs; the ICER for OG was -¥474,758/QALY. OG dominated at the ¥268,074 willingness-to-pay threshold. Sensitivity analysis indicated that variations in LG and OG costs minimally influenced the cost-effectiveness. Probabilistic sensitivity analysis, performed across 10,000 iterations, consistently identified OG as the optimal strategy (100% of iterations). From a Chinese health economics perspective-a framework essential for informing national healthcare resource allocation-OG consistently demonstrated a superior cost-effectiveness compared with LG for LAGC across 1, 3, and 5 years. This longitudinal observation of sustained cost-effectiveness persisted despite the statistically insignificant differences in overall costs and effectiveness between the two procedures.
局部进展期胃癌（LAGC）对手术构成了重大挑战。虽然腹腔镜胃切除术（LG）具有潜在优势，但其在中国相对于开放胃切除术（OG）的成本效益仍不确定。为比较中国LG和OG治疗LAGC的成本效益。采用马尔可夫模型比较LG和OG治疗LAGC的成本效益。概率和效用数据来自已发表的文献。直接医疗成本来自兰州大学第一医院。主要结局是增量成本效益比（ICER），以每获得一个质量调整生命年（QALY）的成本表示，支付意愿阈值为268,074元/QALY。敏感性分析评估模型的稳健性。在1年、3年和5年的时间范围内，对于LAGC，OG的总成本较低且效果优于LG。在5年时，OG的总成本为128,259元，QALY为7.20个，而LG的总成本为136,668元，QALY为7.18个；OG的ICER为-474,758元/QALY。在268,074元的支付意愿阈值下，OG占优。敏感性分析表明，LG和OG成本的变化对成本效益的影响最小。在10,000次迭代中进行的概率敏感性分析一致确定OG为最优策略（100%的迭代）。从中国卫生经济学的角度来看——这是为国家医疗资源分配提供信息的重要框架——在1年、3年和5年期间，与LG相比，OG治疗LAGC的成本效益始终更高。尽管两种手术在总成本和效果上的差异无统计学意义，但这种持续成本效益的纵向观察仍然存在。
