肝切除术与肝动脉化疗栓塞术治疗伴大血管侵犯肝细胞癌成本效果分析

Cost-effectiveness analysis of hepatectomy and TACE for hepatocellular carcinoma with macrovascular invasion

目的依据巴塞罗那临床肝癌分期标准,伴大血管侵犯肝细胞癌患者属于C期,不应实施肝切除术;而我国的肝癌指南指出,肝切除术是此类患者的治疗方式之一。本研究比较肝切除术与肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗此类患者的预后与费用,为医生的治疗提供参考。方法回顾性分析2006-05-01-2015-04-30伴大血管侵犯的肝细胞癌患者118例病例资料,使用倾向性评分匹配消除肝切除术组和TACE组间其他预后因子的混杂作用(匹配后,肝切除术组30例,TACE组60例),然后比较中位生存时间和1年内住院费用,进行成本效果分析。结果 118例患者中位生存时间为7个月(95%CI:5～9),1年内住院费用中位数为39 388元/例(全距:11 830～259 063)。倾向性评分匹配后,肝切除术和TACE治疗患者的中位生存时间分别为16(95%CI:8～24)和5个月(95%CI:4～6),χ~2=14.136,P<0.001;1年内住院费用分别为64 082元/例(全距:38 794～137 783)和32 421元/例(全距:12 395～259 063),Z=-4.904,P<0.001。两种治疗方式的生存时间和费用差异均有统计学意义。肝切除术与TACE相比,增量成本效果比为3 016元/月(95%CI:975～11 148)。结论与TACE相比,接受肝切除术的患者虽然治疗费用较高,但生存时间更长。从卫生经济学的角度看,肝切除术是伴大血管侵犯的肝细胞癌患者更理想的治疗方式。

OBJECTIVE According to Barcelona Clinic Liver Cancer staging system, hepatocellular carcinoma pa-tients with macrovascular invasion belong to stage C,and hepatic resection should not be performed. However,hepatic re-section is one of the treatments for these patients recommended by the clinical guideline of China. In the present study we investigated the prognosis and costs of these patients undergoing hepatic resection or transcatheter arterial chemoemboliza- tion( TACE),aiming to provide references for the clinical practice. METHODS A retrospective analysis was employed in 118 hepatocellular carcinoma patients with macrovascular invasion during May 1,2006 to April 30,2015. The propensity score matching was used to mitigate the heterogeneity of patients between different treatments (after matching,hepatic re-section 30 patients vs TACE 60 patients). The median survival time and cost were compared for cost-effectiveness analy-sis. RESULTS The median survival time of the 118 patients was 7 months (95%CI:5-9) and the median cost in the first year was 39 388 RMB/patient (Range: 11 830 - 259 063). After propensity score matching,the patients undergoing hepat-ic resection had more favorable outcomes (median survival time: 16 months?95%CI:8 - 24) than those treated with TACE (median survival time: 5 months, 95 % Cl: 4 - 6,X^2 = 14. 136, P<0. 001). The first-year median costs of hepatic resection and TACE were 64 082 RMB/patient (Range:38 794 -137 783) and 32 421 RMB/patient (Range: 12 395 - 259 063) 9re-spectively (Z=-4. 904, P<0. 001 ),the incremental cost-effectiveness ratio was 3 016 RMB/patient (95% Cl: 975 - 11 148). CONCLUSIONS Hepatectomy can offer much better prognoses for patients than TACE^and the incremental costs are completely acceptable. Hepatectomy is the preferred treatment for hepatocellular carcinoma patients with macro- vascular invasion in the perspective of health economics.