背景:辅助放疗是早期乳腺癌患者治愈性治疗的关键组成部分。近年来,在我们的组织中,该人群首选两种加速部分乳房照射(APBI)技术:基于电子的术中放射治疗(IORT)和基于直线加速器的外部束放射治疗,特别是调强放射治疗(IMRT)。与IMRT相比,最近发布的评估这些技术的长期随访数据激发了对IORT的健康技术重新评估。
方法:我们开发了一个马尔可夫模型来模拟早期乳腺癌女性的健康状态转变,在使用IORT或IMRT技术进行肿块切除术和辅助APBI后。从投资角度评估了私人医疗服务提供者的成本效益,使用寿命年(LYs)和无复发寿命年(RFLYs)作为获益的衡量标准,以及各自的质量调整。预期成本和收益,并报告了增量成本效益比(ICER)。最后,在IORT患者中使用较低的IORT局部复发和转移率进行敏感性和情景分析以评估成本效益。如果设备维护费用被取消。
结果:在所有情况下,IORT技术均由IMRT主导(即,更少的好处和更大的成本)。尽管在福利方面发现了微小的差异,尤其是对于Lys来说,IORT的成本要高得多。对于IORT复发率和转移率较低的敏感性分析,和没有设备维护成本的情景分析,IORT仍然以IMRT为主。
结论:对于这一组患者,IMRT是,至少,在预期收益方面不劣于IORT,成本大大降低。因此,应考虑IORT撤资,支持在这些患者中使用IMRT。
BACKGROUND: Adjuvant radiotherapy represents a key component in curative-intent treatment for early-stage breast cancer patients. In recent years, two accelerated partial breast irradiation (APBI) techniques are preferred for this population in our organization: electron-based Intraoperative radiation therapy (IORT) and Linac-based External Beam Radiotherapy, particularly Intensity-modulated radiation therapy (IMRT). Recently published long-term follow-up data evaluating these technologies have motivated a health technology reassessment of IORT compared to IMRT.
METHODS: We developed a Markov model to simulate health-state transitions from a cohort of women with early-stage breast cancer, after lumpectomy and adjuvant APBI using either IORT or IMRT techniques. The cost-effectiveness from a private health provider perspective was assessed from a disinvestment point of view, using life-years (LYs) and recurrence-free life-years (RFLYs) as measure of benefits, along with their respective quality adjustments. Expected costs and benefits, and the incremental cost-effectiveness ratio (ICER) were reported. Finally, a sensitivity and scenario analyses were performed to evaluate the cost-effectiveness using lower IORT local recurrence and metastasis rates in IORT patients, and if equipment maintenance costs are removed.
RESULTS: IORT technology was dominated by IMRT in all cases (i.e., fewer benefits with greater costs). Despite small differences were found regarding benefits, especially for LYs, costs were considerably higher for IORT. For sensitivity analyses with lower recurrence and metastasis rates for IORT, and scenario analyses without equipment maintenance costs, IORT was still dominated by IMRT.
CONCLUSIONS: For this cohort of patients, IMRT was, at least, non-inferior to IORT in terms of expected benefits, with considerably lower costs. As a result, IORT disinvestment should be considered, favoring the use of IMRT in these patients.