螺旋断层放射治疗系统的成本效果分析

Cost-effectiveness analysis of TOMO system

目的:评估医院在用螺旋断层放射治疗设备(TOMO)的成本效果,为设备配置和管理提供参考;方法:收集华北和华南地区3所医院(分别为医院A、医院B和医院C)的258例鼻咽癌、宫颈癌和肺癌3类患者放射治疗相关信息,按照治疗方法的不同,将其分为TOMO组(119例)和直线加速器组(139例);对两组患者治疗中的成本和效果采用自助法(bootstrapping)计算增量成本效果比。结果:在放射治疗中TOMO与医用直线加速器相比,其剂量分布、减少部分重要器官辐射剂量和不良反应等短期效果具有优势,其中以鼻咽癌患者最优,两组脊髓、双侧腮腺接受放射剂量比较,差异有统计学意义(t=5.156,t=5.261;P<0.05)。但TOMO组治疗费用更高,在鼻咽癌患者中,TOMO组每降低重要器官1 Gy辐射剂量需多花费765元,每降低1%器官的中高等毒性损伤需要多花2341元;在医院C中两组鼻咽癌、肺癌和宫颈癌患者治疗平均总费用比较,差异有统计学意义(t=5.269,t=4.378,t=3.350;P<0.05)。结论:TOMO在部分适应证治疗中显示了短期成本效果,但是远期的成本效果证据尚不充分,有待进一步研究。

Objective:To assess the cost-effectiveness of using tomotherapy(TOMO)equipment of hospital so as to provide references for further configuration and management of equipment.Methods:The relevant information of radiotherapy of 258 patients with nasopharynx cancer,cervical cancer and lung cancer in 3 hospitals(A,B and C)of North China and South China were collected.They were divided into TOMO group(119 cases)and linear accelerator group(139 cases)according to different therapeutic method.The bootstrapping was adopted to calculate incremental cost-effectiveness ratio of cost and effectiveness in treatments of two groups.Results:Compared with linear accelerator,the dose distribution,the reduced radiation dose in part of important organ and the adverse reaction and other short-term effect in TOMO radiotherapy had advantages.Among of them,those of patients with nasopharynx cancer were optimal.And the differences of the received radiation doses on spinal cord and bilateral parotid glands between two groups were significant(t=5.156,t=5.261,P<0.05).But the treatment cost of TOMO group was more expensive,and TOMO group need pay more expenditure which was CNY 765 when reduced 1 Gy radiation dose on important organs of patients with nasopharynx cancer,and TOMO group need pay more CNY 2341 when reduced 1%of poisonousness injure of middle and high level on organ.The differences of average total cost of patients with nasopharynx cancer,patients with lung cancer and patients with cervical cancer in C hospital between two groups were significant(t=5.269,t=4.378,t=3.350,P<0.05).Conclusion:TOMO indicates short-period cost effect in the treatment of the part of indication,but the evidence of long-term cost effect of TOMO is not sufficient,and the long-term effect need further research.