Cost-effectiveness of stereotactic body radiation therapy versus video assisted thoracic surgery in medically operable stage I non-small cell lung cancer: A modeling study

被引：22

作者：

Wolff, Henri B. ^{[1
]}

Alberts, Leonie ^{[2
]}

van der Linden, Naomi ^{[3
]}

Bongers, Mathilda L. ^{[1
]}

Verstegen, Naomi E. ^{[4
]}

Lagerwaard, Frank J. ^{[4
]}

Hofman, Frederik N. ^{[5
]}

Uyl-de Groot, Carin A. ^{[3
,6
]}

Senan, Suresh ^{[4
]}

El Sharouni, Sherif Y. ^{[7
]}

Kastelijn, Elisabeth A. ^{[2
]}

Schramel, Franz M. N. H. ^{[2
]}

Coupe, Veerle M. H. ^{[1
]}

机构：

[1] Amsterdam UMC, Dept Epidemiol & Biostat, Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands

[2] St Antonius Hosp, Dept Pulmonol, Nieuwegein, Netherlands

[3] Erasmus Univ, Erasmus Sch Hlth Policy & Management, Dept Hlth Technol Assessment, Rotterdam, Netherlands

[4] Amsterdam UMC, Dept Radiat Oncol, Amsterdam, Netherlands

[5] St Antonius Hosp, Dept Cardiothorac Surg, Nieuwegein, Netherlands

[6] Erasmus Univ, Inst Med Technol Assessment, Rotterdam, Netherlands

[7] Univ Med Ctr Utrecht, Dept Radiotherapy, Utrecht, Netherlands

来源：

LUNG CANCER | 2020年 / 141卷

关键词：

SBRT; VATS; Cost-effectiveness; Microsimulation; NSCLC; ABLATIVE RADIOTHERAPY; SURGICAL RESECTION; LOBECTOMY; OUTCOMES; MORTALITY; SELECTION; SURVIVAL; BREAST; DEATH; SABR;

D O I：

10.1016/j.lungcan.2020.01.011

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Objectives: Stage I non-small cell lung cancer (NSCLC) can be treated with either Stereotactic Body Radiotherapy (SBRT) or Video Assisted Thoracic Surgery (VATS) resection. To support decision making, not only the impact on survival needs to be taken into account, but also on quality of life, costs and cost-effectiveness. Therefore, we performed a cost-effectiveness analysis comparing SBRT to VATS resection with respect to quality adjusted life years (QALY) lived and costs in operable stage I NSCLC. Materials and methods: Patient level and aggregate data from eight Dutch databases were used to estimate costs, health utilities, recurrence free and overall survival. Propensity score matching was used to minimize selection bias in these studies. A microsimulation model predicting lifetime outcomes after treatment in stage I NSCLC patients was used for the cost-effectiveness analysis. Model outcomes for the two treatments were overall survival, QALYs, and total costs. We used a Dutch health care perspective with 1.5 % discounting for health effects, and 4 % discounting for costs, using 2018 cost data. The impact of model parameter uncertainty was assessed with deterministic and probabilistic sensitivity analyses. Results: Patients receiving either VATS resection or SBRT were estimated to live 5.81 and 5.86 discounted QALYs, respectively. Average discounted lifetime costs in the VATS group were 029,269 versus 021,175 for SBRT. Difference in 90-day excess mortality between SBRT and VATS resection was the main driver for the difference in QALYs. SBRT was dominant in at least 74 % of the probabilistic simulations. Conclusion: Using a microsimulation model to combine available evidence on survival, costs, and health utilities in a cost-effectiveness analysis for stage I NSCLC led to the conclusion that SBRT dominates VATS resection in the majority of simulations.

引用

页码：89 / 96

页数：8

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