Truijen Saskia P M, Vissers Pauline A J, Nieuwenhuijzen Grard A P, van der Sangen Maurice J C, Siersema Peter D, Slingerland Marije, Mohammad Nadia H, Beerepoot Laurens V, van Berge Henegouwen Mark I, van der Sluis Pieter C, Rosman Camiel, Kouwenhoven Ewout A, Aktaş Hüseyin, van Laarhoven Hanneke W M, Uyl-de Groot Carin A, Verhoeven Rob H A
Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Boven Clarenburg 2, 3511 CV, Utrecht, the Netherlands.
Department of Rheumatology, Maastricht University Medical Center, and Care and Public Health Institute (CAPHRI), Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Dis Esophagus. 2025 Jul 3;38(4). doi: 10.1093/dote/doaf057.
For potentially curable esophageal cancer (EC) and gastric cancer (GC) patients, the probability of treatment with curative intent varies between hospitals and is associated with survival. This study examines the effect of this variation on health economics outcomes and cost-effectiveness. We performed a cost-effectiveness analysis from a societal perspective in potentially curable EC or GC patients selected from the Netherlands Cancer Registry. Resource use and costs were estimated for each treatment strategy from diagnosis until five years follow-up using a top-down costing method. Hospitals were divided into tertiles of low, medium, or high probability of treatment with curative intent using multilevel multivariable logistic regression. The primary outcome was the incremental cost-effectiveness ratio (ICER). Mean total costs per patient was not significantly different between low, medium, and high probability hospitals for EC (n = 9468) (€47,532 vs. €47,384 vs. €47,825), while for GC (n = 3085) costs were significantly lower in low compared to medium and high probability hospitals (€27,759 vs. €30,183 vs. €29,589, both P < 0.001). Costs per quality adjusted life year (QALY) were slightly lower in high probability hospitals for both EC and GC (EC: €29,181 vs. €28,646 vs. €27,659, GC: €25,003 vs. €22,505 vs. €20,495). ICERs were highest for high vs. medium probability hospitals for EC (€4900/QALY) and for medium vs. low probability hospitals for GC (€10,539/QALY). Variation in treatment with curative intent between hospitals affects health economics outcomes to a limited extent. Although all hospital comparisons were cost-effective, for the highest QALY gain, it is recommended to treat potentially curable patients as in high probability hospitals.
对于潜在可治愈的食管癌（EC）和胃癌（GC）患者，进行根治性治疗的概率在不同医院之间存在差异，且与生存率相关。本研究考察了这种差异对卫生经济学结果和成本效益的影响。我们从社会角度对从荷兰癌症登记处选取的潜在可治愈的EC或GC患者进行了成本效益分析。使用自上而下的成本核算方法，对每种治疗策略从诊断到五年随访期间的资源使用和成本进行了估计。采用多水平多变量逻辑回归将医院分为根治性治疗概率低、中、高的三分位数。主要结果是增量成本效益比（ICER）。对于EC患者（n = 9468），低、中、高概率医院的每位患者平均总成本无显著差异（分别为47,532欧元、47,384欧元和47,825欧元），而对于GC患者（n = 3085），低概率医院的成本显著低于中、高概率医院（分别为27,759欧元、30,183欧元和29,589欧元，P均<0.001）。对于EC和GC患者，高概率医院的每质量调整生命年（QALY）成本略低（EC：分别为29,181欧元、28,646欧元和27,659欧元；GC：分别为25,003欧元、22,505欧元和20,495欧元）。对于EC患者，高概率医院与中概率医院相比的ICER最高（4900欧元/QALY），对于GC患者，中概率医院与低概率医院相比的ICER最高（10,539欧元/QALY）。医院之间根治性治疗的差异对卫生经济学结果的影响有限。尽管所有医院比较都是具有成本效益的，但为了获得最高的QALY增益，建议按照高概率医院的方式治疗潜在可治愈的患者。
