PDF(Pubmed)
Abstract：
UNASSIGNED: To determine the cost of two surgical treatment approaches for vulvar Paget\'s disease and model the cost-effectiveness considering differences in recurrence and reoperation over time.
UNASSIGNED: We assessed cost-effectiveness between excision guided by Mohs micrographic surgery (MMS-E) and traditional wide local excision (WLE). We examined billing data from patients with vulvar Paget\'s disease who underwent MMS-E (cases, n = 24, 2018-2022) or WLE (controls, n = 64, 1990-2020). We created typical treatment bundles incorporating physician-administered services and facility costs standardized to Medicare reimbursements in 2022 United States Dollars (USD). The primary measure of effectiveness was disease-free years of life. A secondary analysis estimated quality-adjusted life years (QALY). A Markov model simulated treatment pathways over a 10-year time horizon. Transition probabilities were based on institutional recurrence rates (3-year RR 6.7 % for MMS-E vs 34.1 % for WLE). We used a willingness-to-pay threshold of 100,000 USD per QALY.
UNASSIGNED: The cost of a single surgical episode was 34,664 USD for MMS-E and 14,969 USD for WLE. In the setting of lower recurrence rates with MMS-E, the incremental cost was 12,789 USD per disease-free year gained. A secondary analysis incorporating QALY showed an incremental cost of 72,820 USD per QALY.
UNASSIGNED: MMS-E appears to be a cost-effective treatment for vulvar Paget\'s disease compared to historic standard of care. Our ability to estimate quality of life gained by avoiding disease recurrence was limited by scant data for this rare condition; thus, future studies incorporating health utility values are needed to facilitate a more comprehensive analysis.
UNASSIGNED: We assessed cost-effectiveness between excision guided by Mohs micrographic surgery (MMS-E) and traditional wide local excision (WLE). We examined billing data from patients with vulvar Paget\'s disease who underwent MMS-E (cases, n = 24, 2018-2022) or WLE (controls, n = 64, 1990-2020). We created typical treatment bundles incorporating physician-administered services and facility costs standardized to Medicare reimbursements in 2022 United States Dollars (USD). The primary measure of effectiveness was disease-free years of life. A secondary analysis estimated quality-adjusted life years (QALY). A Markov model simulated treatment pathways over a 10-year time horizon. Transition probabilities were based on institutional recurrence rates (3-year RR 6.7 % for MMS-E vs 34.1 % for WLE). We used a willingness-to-pay threshold of 100,000 USD per QALY.
UNASSIGNED: The cost of a single surgical episode was 34,664 USD for MMS-E and 14,969 USD for WLE. In the setting of lower recurrence rates with MMS-E, the incremental cost was 12,789 USD per disease-free year gained. A secondary analysis incorporating QALY showed an incremental cost of 72,820 USD per QALY.
UNASSIGNED: MMS-E appears to be a cost-effective treatment for vulvar Paget\'s disease compared to historic standard of care. Our ability to estimate quality of life gained by avoiding disease recurrence was limited by scant data for this rare condition; thus, future studies incorporating health utility values are needed to facilitate a more comprehensive analysis.
摘要：
■确定外阴Paget病的两种手术治疗方法的成本，并考虑复发和再手术随时间的差异对成本效益进行建模。
■我们评估了Mohs显微手术（MMS-E）指导下的切除与传统的广泛局部切除（WLE）之间的成本效益。我们检查了接受MMS-E的外阴Paget病患者的账单数据(病例，n=24，2018-2022年)或WLE(控制，n=64，1990-2020年）。我们创建了典型的治疗捆绑包，其中包括医生管理的服务和设施成本，这些费用在2022年标准化为医疗保险报销美元（USD）。有效性的主要衡量标准是无病寿命。二次分析估计了质量调整寿命年(QALY)。马尔可夫模型模拟了10年时间范围内的治疗途径。过渡概率基于机构复发率（MMS-E的3年RR为6.7％，WLE为34.1％）。我们使用了每QALY100,000美元的支付意愿门槛。
■MMS-E单次手术的费用为34,664美元，WLE为14,969美元。在MMS-E复发率较低的情况下，每获得无病年的增量成本为12,789美元.纳入QALY的二次分析显示，每个QALY的增量成本为72,820美元。
■与历史护理标准相比，MMS-E似乎是外阴Paget病的一种具有成本效益的治疗方法。我们估计通过避免疾病复发获得的生活质量的能力受到这种罕见情况的数据不足的限制；因此，需要纳入健康效用值的未来研究，以促进更全面的分析。
■我们评估了Mohs显微手术（MMS-E）指导下的切除与传统的广泛局部切除（WLE）之间的成本效益。我们检查了接受MMS-E的外阴Paget病患者的账单数据(病例，n=24，2018-2022年)或WLE(控制，n=64，1990-2020年）。我们创建了典型的治疗捆绑包，其中包括医生管理的服务和设施成本，这些费用在2022年标准化为医疗保险报销美元（USD）。有效性的主要衡量标准是无病寿命。二次分析估计了质量调整寿命年(QALY)。马尔可夫模型模拟了10年时间范围内的治疗途径。过渡概率基于机构复发率（MMS-E的3年RR为6.7％，WLE为34.1％）。我们使用了每QALY100,000美元的支付意愿门槛。
■MMS-E单次手术的费用为34,664美元，WLE为14,969美元。在MMS-E复发率较低的情况下，每获得无病年的增量成本为12,789美元.纳入QALY的二次分析显示，每个QALY的增量成本为72,820美元。
■与历史护理标准相比，MMS-E似乎是外阴Paget病的一种具有成本效益的治疗方法。我们估计通过避免疾病复发获得的生活质量的能力受到这种罕见情况的数据不足的限制；因此，需要纳入健康效用值的未来研究，以促进更全面的分析。
