■这是预先计划好的,来自LIGRO试验的健康经济学评估。100例结直肠癌肝转移(CRLM)和标准化未来肝残留<30%的患者被随机分配到联合肝分区和门静脉结扎进行分期肝切除术(ALPPS)或两阶段肝切除术(TSH)。
■TSH,是先进的CRLM中的一种既定方法。ALPPS的出现提供了提高的切除率和存活率。医疗保健成本和健康结果,将健康相关生活质量(HRQoL)和生存率结合到质量调整生命年(QALYs)中,ALPPS和TSH之前没有进行过评估和比较。
■比较了从治疗开始到2年的成本和QALY。成本是根据资源使用估算的,包括所有的外科手术,干预后的停留时间,诊断程序和化疗,并应用瑞典单位成本。QALY是通过结合生存率和HRQoL数据来估计的,后者用EQ-5D3L进行评估。将每种治疗策略的估计成本和QALY合并为增量成本效益比(ICER)。非参数自举用于评估增量成本和QALY的联合分布。
■ALPPS和TSH之间的平均成本差异为12,662欧元,[95%置信区间(CI):-10,728-36,051;P=0.283]。寿命年和QALYs的相应平均差为0.1296(95%CI:-0.12-0.38;P=0.314)和0.1285(95%CI:-0.11-0.36;P=0.28),分别。作为结果,ICER的QALY和生命年分别为93,186和92,414,分别。
■根据两年的数据,ALPPS的成本效益是不确定的。进一步研究,需要探索超过2年的成本和健康结果。
UNASSIGNED: This is a preplanned, health economic evaluation from the LIGRO trial. One hundred patients with colorectal liver metastases (CRLM) and standardized future liver remnant <30% were randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or two-staged hepatectomy (TSH).
UNASSIGNED: TSH, is an established method in advanced CRLM. ALPPS has emerged providing improved resection rate and survival. The health care costs and health outcomes, combining health-related quality of life (HRQoL) and survival into quality-adjusted life years (QALYs), of ALPPS and TSH have not previously been evaluated and compared.
UNASSIGNED: Costs and QALYs were compared from treatment start up to 2 years. Costs are estimated from resource use, including all surgical interventions, length of stay after interventions, diagnostic procedures and chemotherapy, and applying Swedish unit costs. QALYs were estimated by combining survival and HRQoL data, the latter being assessed with EQ-5D 3L. Estimated costs and QALYs for each treatment strategy were combined into an incremental cost-effectiveness ratio (ICER). Nonparametric bootstrapping was used to assess the joint distribution of incremental costs and QALYs.
UNASSIGNED: The mean cost difference between ALPPS and TSH was 12,662€, [95% confidence interval (CI): -10,728-36,051; P = 0.283]. Corresponding mean difference in life years and QALYs was 0.1296 (95% CI: -0.12-0.38; P = 0.314) and 0.1285 (95% CI: -0.11-0.36; P = 0.28), respectively. The ICER was 93,186 and 92,414 for QALYs and life years as outcomes, respectively.
UNASSIGNED: Based on the 2-year data, the cost-effectiveness of ALPPS is uncertain. Further research, exploring cost and health outcomes beyond 2 years is needed.