■适当的营养支持,包括补充家庭肠外营养(sHPN),可以改善营养不良癌症患者的预后和生活质量(Qol)。我们旨在从中国医疗保健的角度探讨sHPN对无法治愈的胃肠道癌症患者的成本效益。
■临床数据来自一项随机对照试验(NCT02066363)。患者被随机分为sHPN组或非sHPN组(接受最佳实践营养护理)。建立了一个周期为6周的马尔可夫模型。费用是从当地医院获得的,影响参数包括质量调整寿命年(QALY),Qol,身体质量指数,无脂质量(FFM),FFM指数,握力,和6分钟的步行测试。进行敏感性分析时,支付意愿(WTP)设定为人均国内生产总值3($29,307/QALY)。
■当将QALY视为实用程序时,增量成本-效果比(ICER)为24,289.17美元,sHPN组和非sHPN组之间的增量成本为2,051.18美元,增量QALY为0.0844美元.此外,我们从多个维度探索了sHPN的成本效益,我们分析了不同访视时的各种效应参数;结果显示,除了第2次访视时的握把参数外,sHPN组的患者具有更好的获益。敏感性分析显示了公用事业在sHPN组中的影响,但sHPN组仍然具有成本效益,WTP为2500美元/QALY。
■在中国,sHPN对于无法治愈的胃肠道癌症患者具有成本效益,建议在临床实践中的进一步应用,为临床决策和定价提供参考。
UNASSIGNED: Appropriate nutritional support, including supplemental home parenteral nutrition (sHPN), may improve prognosis and quality of life (Qol) of malnourished cancer patients. We aimed to explore the cost-effectiveness of sHPN for incurable gastrointestinal cancer patients from the Chinese healthcare perspective.
UNASSIGNED: Clinical data were extracted from a randomized controlled trial (NCT02066363). Patients were randomized into the sHPN group or the non-sHPN group (receiving best practice nutritional care). A Markov model was established with a 6-week cycle length. Costs were acquired from local hospitals, effect parameters included quality-adjusted life year (QALY), Qol, body mass index, fat-free mass (FFM), FFM index, handgrip strength, and a 6-min walking test. Sensitivity analyses were conducted with a willingness-to-pay (WTP) set at 3 per capita gross domestic product ($29,307/QALY).
UNASSIGNED: When considering QALY as a utility, the incremental cost-effectiveness ratio (ICER) was $24,289.17, with an incremental cost of $2,051.18 and an incremental QALY of 0.0844 between the sHPN group and the non-sHPN group. Furthermore, we explored the cost-effectiveness of sHPN from multidimensions, where we analyzed various effect parameters at different visits; the results showed a superior benefit for patients in the sHPN group except for the handgrip parameter at visit 2. Sensitivity analysis demonstrated the influence of utilities in the sHPN group, but the sHPN group was still cost-effective with a WTP of $2,500/QALY.
UNASSIGNED: In
China, sHPN was cost-effective for patients with incurable gastrointestinal cancer, which suggested further applications in clinical practice and provided references for clinical decisions and pricing.