我国手术切除与射频消融治疗早期肝细胞癌的经济学评价

Economic Evaluation on Surgical Resection and Radiofrequency Ablation for Early Hepatocellular Carcinoma in China

目的:对我国手术切除(SR)和射频消融(RFA)治疗符合Milan标准且肝功能为Child-Pugh A或B级的早期肝细胞癌(HCC )患者的成本-效用进行比较。方法通过机构调查、系统综述和专家咨询收集相关数据,并从卫生系统视角构建Markov模型,比较手术切除和射频消融的成本-效用分析。结果当模型运行时间W 3年时,RFA比SR更具成本-效果;而当模型运行时间>3年时,SR-RFA的1CER值均低于3倍人均GDP, SR更具成本-效果。概率敏感性分析显示,当模型运行20年、意愿支付阈值为3倍人均GDP时,SR比RFA更具有成本-效果的概率为75.2%。结论从长期疗效和经济性来看,早期HCC的治疗应首选手术切除。

Objective: To compare cost-utility between surgical resection(SR) and radiofrequency ablation(RFA) for early hepatocellular carcinoma(HCC) with Child-Pugh A/B liver function and Milan criteria. Methods: From the perspective of health system, a Markov model was constructed to compare the cost-utilities between SR and RFA, based on the relevant data from institutional surveys, systematic reviews and expert consultation. Results: When the model ran for <3 years, RFA was more cost- effective than SR, while the model ran for >3 years, the ICER value of SR-RFA was less than 3 times of GDP per capita and SR was more cost-effective. Probabilistic sensitivity analysis showed that when the model ran for 20 years and the willingness to pay threshold was 3 times of GDP per capita, the probability of SR being more cost-effective than RFA was 75.2%. Conclusion: Considering long term efficacy and economy, SR should the first choice for early HCC.