PDF(Pubmed)
Abstract：
OBJECTIVE: The PARCER trial provided level I evidence for image-guided intensity-modulated radiation therapy (IG-IMRT) in patients with cervical cancer. Further information regarding long-term financial impact is imperative for adoption into the National Cancer Grid of India cervical cancer resource-stratified guidelines.
METHODS: Patient data from the PARCER trial were analyzed to evaluate the cost implications of transitioning to IG-IMRT. Lacking differences in outcomes between the three-dimensional conformal radiation (3D-CRT) and IG-IMRT, differences in treatment costs, adverse event incidence, and toxicity management costs were examined. The overall financial impact was estimated by adding the treatment costs, toxicity management, and wage loss. This was extrapolated nationally to determine if a transition to IG-IMRT would be feasible for the Indian health care system.
RESULTS: Of the 300 patients in the PARCER trial, 93 faced grades ≥2 adverse events (3D-CRT = 59, IG-IMRT = 34). Patients in the 3D-CRT and IG-IMRT arms spent an average of 2.39 years and 1.96 years in toxicity, respectively. The average toxicity management and the yearly financial impact per patient were, respectively, 1.50 and 1.44 times higher for 3D-CRT patients compared with IG-IMRT patients. Extrapolation to the national level showed that treatment with 3D-CRT led to a 2.88 times higher cost ratio when compared with treatment with IG-IMRT.
CONCLUSIONS: Although the initial costs of IG-IMRT are high, on the basis of longitudinal data, it is financially inefficient to treat with 3D-CRT. Resource-stratified guidelines should include longitudinal health intervention costs rather than solely initial costs for policy decisions to implement advanced radiation technology.
METHODS: Patient data from the PARCER trial were analyzed to evaluate the cost implications of transitioning to IG-IMRT. Lacking differences in outcomes between the three-dimensional conformal radiation (3D-CRT) and IG-IMRT, differences in treatment costs, adverse event incidence, and toxicity management costs were examined. The overall financial impact was estimated by adding the treatment costs, toxicity management, and wage loss. This was extrapolated nationally to determine if a transition to IG-IMRT would be feasible for the Indian health care system.
RESULTS: Of the 300 patients in the PARCER trial, 93 faced grades ≥2 adverse events (3D-CRT = 59, IG-IMRT = 34). Patients in the 3D-CRT and IG-IMRT arms spent an average of 2.39 years and 1.96 years in toxicity, respectively. The average toxicity management and the yearly financial impact per patient were, respectively, 1.50 and 1.44 times higher for 3D-CRT patients compared with IG-IMRT patients. Extrapolation to the national level showed that treatment with 3D-CRT led to a 2.88 times higher cost ratio when compared with treatment with IG-IMRT.
CONCLUSIONS: Although the initial costs of IG-IMRT are high, on the basis of longitudinal data, it is financially inefficient to treat with 3D-CRT. Resource-stratified guidelines should include longitudinal health intervention costs rather than solely initial costs for policy decisions to implement advanced radiation technology.
摘要：
目的：PARCER试验为宫颈癌患者的图像引导调强放疗（IG-IMRT）提供了I级证据。有关长期财务影响的更多信息必须纳入印度国家癌症网格宫颈癌资源分层指南。
方法：分析PARCER试验的患者数据，以评估过渡到IG-IMRT的成本影响。三维适形辐射（3D-CRT）和IG-IMRT之间的结果缺乏差异，治疗成本的差异，不良事件发生率，并检查了毒性管理成本。总体财务影响是通过加上治疗费用来估计的，毒性管理，和工资损失。在全国范围内进行了推断，以确定过渡到IG-IMRT对于印度的医疗保健系统是否可行。
结果：在PARCER试验的300名患者中，93例≥2级不良事件（3D-CRT=59，IG-IMRT=34）。3D-CRT和IG-IMRT组的患者平均毒性为2.39年和1.96年，分别。平均毒性管理和每名患者的年度财务影响为，分别,与IG-IMRT患者相比，3D-CRT患者高1.50和1.44倍。对国家水平的推断表明，与IG-IMRT治疗相比，3D-CRT治疗的成本比高出2.88倍。
结论：尽管IG-IMRT的初始成本很高，根据纵向数据，用3D-CRT治疗在经济上效率低下。资源分层指南应包括纵向健康干预成本，而不仅仅是实施先进辐射技术的政策决策的初始成本。
方法：分析PARCER试验的患者数据，以评估过渡到IG-IMRT的成本影响。三维适形辐射（3D-CRT）和IG-IMRT之间的结果缺乏差异，治疗成本的差异，不良事件发生率，并检查了毒性管理成本。总体财务影响是通过加上治疗费用来估计的，毒性管理，和工资损失。在全国范围内进行了推断，以确定过渡到IG-IMRT对于印度的医疗保健系统是否可行。
结果：在PARCER试验的300名患者中，93例≥2级不良事件（3D-CRT=59，IG-IMRT=34）。3D-CRT和IG-IMRT组的患者平均毒性为2.39年和1.96年，分别。平均毒性管理和每名患者的年度财务影响为，分别,与IG-IMRT患者相比，3D-CRT患者高1.50和1.44倍。对国家水平的推断表明，与IG-IMRT治疗相比，3D-CRT治疗的成本比高出2.88倍。
结论：尽管IG-IMRT的初始成本很高，根据纵向数据，用3D-CRT治疗在经济上效率低下。资源分层指南应包括纵向健康干预成本，而不仅仅是实施先进辐射技术的政策决策的初始成本。
