内镜手术治疗复发性rT1-rT3期鼻咽癌基于马尔可夫模型的成本-效果分析

Cost-effectiveness of endoscopic nasopharyngectomy in locally recurrent rT1-rT3 nasopharyngeal carcinoma:a study based on Markov model

目的从医疗保健和经济学的角度, 通过内镜手术对比再程放疗治疗局部复发性鼻咽癌(recurrent nasopharyhgeal carcinoma, rNPC)的成本-效果分析, 为临床选择rNPC的治疗方案提供参考。方法纳入2011年9月30日至2017年1月16日于中山大学附属第一医院、佛山市第一人民医院、中山大学肿瘤防治中心接受治疗的200例患者, 经组织病理学检查诊断为局部rT1-rT3期rNPC, 并按1︰1随机分配至内镜手术组和再程放疗组。内镜手术组中男性69例, 女性31例, 年龄38~55岁;再程放疗组中男性72例, 女性28例, 年龄41~54岁。使用马尔可夫模型对队列进行回顾性成本效益分析。采用不同治疗方式的生存数据、质量生命调整年(quality-adjusted life year, QALY)以及相应治疗的费用数据用于建立模型。通过Weibull拟合原始数据, 计算时间依赖的状态转移概率, 并使用β回归将欧洲癌症治疗与研究组织生活质量量表-C30转化为不同状态的效用值。通过马尔可夫模型得出增量成本-效果比(incremental cost-effectiveness ratio, ICER), 并进行敏感性分析。结果内镜手术总费用为29 611.88元, 调强放疗总费用为110 082.51元, 手术对比放疗治疗局部rNPC的ICER为-85 555.88元/QALY, 小于3倍我国人均国内生产总值, 在居民可接受的支付意愿内。敏感性分析显示再程放疗的费用对ICER的影响最大, 在参数波动范围内ICER稳定。结论内镜手术对比放疗治疗局部rNPC具有经济性。

Objective To perform a cost-effectiveness analysis of endoscopic surgery versus intensity-modulated radiotherapy in the treatment of locally recurrent nasopharyngeal carcinoma(rNPC)from a health-economic perspective.Methods From September 30,2011 to January 16,2017,a total of 200 patients were enrolled in the First Affiliated Hospital of Sun Yat-sen University,the First People′s Hospital of Foshan,and Sun Yat-sen University Cancer Center.These patients were diagnosed as locally rT1-rT3 stage rNPC and were randomly assigned 1︰1 to the endoscopic surgery group(ENPG)and the intensity-modulated radiotherapy group(IMRT).There were 69 males and 31 females in ENPG,aging from 38 to 55 years.There were 72 males and 28 females in IMRT aging from 41 to 54 years.A retrospective cost-effectiveness analysis of the cohort was conducted using a Markov model.For each modality,data on survival and quality-adjusted life year(QALY)were sourced from relevant articles,and cost prices were included regarding treatment.Weibull distribution was used to estimate time-dependent transition probability.Beta-regression was used to convert the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(EORTC QLQ-C30)to utility.Results The total cost of ENPG was 29611.88 yuan,and the total cost of IMRT was 110082.51 yuan.The incremental cost-effectiveness ratio(ICER)of ENPG versus radiotherapy for locally rNPC was-85555.88 yuan/QALY,which was less than 3 times of Chinese gross domestic product(GDP)per capita.Sensitivity analysis showed that the cost of IMRT had the greatest impact on ICER.ICER was stable within 10%fluctuation of all the parameters.Conclusion It is economical cost-effective to treat locally rNPC with ENGP versus IMRT.