Cost-Effectiveness of Low-Field Intraoperative Magnetic Resonance in Glioma Surgery.
Cost-Effectiveness of Low-Field Intraoperative Magnetic Resonance in Glioma Surgery.
复制标题
DOI：
10.3389/fonc.2020.586679
复制
发表时间：
2020
影响因子：
4.7
通讯作者：
Enseñat J
中科院分区：
文献类型：
--
作者：
Garcia-Garcia S;García-Lorenzo B;Ramos PR;Gonzalez-Sanchez JJ;Culebras D;Restovic G;Alcover E;Pons I;Torales J;Reyes L;Sampietro-Colom L;Enseñat J
低场术中磁共振（LF-iMR）已证明轴内肿瘤切除范围略有增加，同时保留患者的神经结局。然而，这种改进是否具有成本效益仍然存在争议。在这项临床研究中，我们试图评估在胶质瘤手术中实施LF-iMR的成本效益。前瞻性收集了接受LF-iMR引导的胶质瘤手术（具有大体全切除（GTR）意图）的患者，并与未使用该技术的历史队列进行了比较。收集并分析了社会人口统计学和临床变量（术前和术后KPS;组织病理学分类;切除程度;术后并发症;第一年内需要再次干预和术后1年生存率）。在两组中评估有效性变量：术后Karnofsky体能状态量表（pKPS）;总生存期（OS）;无进展生存期（PFS）;以及一个变量，该变量解释了大于次全切除且术后KPS相同或更高的患者数量（R-KPS）。成本效益分析考虑了与治疗相关的所有术前、手术和术后成本（诊断程序、假体、手术时间、住院、耗材、LF-iMR器械等）。确定性和概率模拟进行评估我们的分析的一致性。50例患者在LF-iMR辅助下进行手术，146例属于对照组。干预组GTR率、pKPS、R-KPS、PFS和1年OS分别高13.8%（无显著性）、7分（p <0.05）、17%（p <0.05）、38天（p < 0.05）和3.7%（无显著性）。成本效益分析显示，干预组每例患者的平均增量成本为789欧元。增量成本效益比为pKPS每增加一个百分点111欧元，无进展日每增加一天21欧元，R-KPS每增加一个百分点46欧元。与传统技术相比，在LF-iMR引导下手术的胶质瘤患者的功能结局更好，切除率更高，并发症更少，PFS率更高，但预期寿命相似。在效率方面，LF-iMR在R-KPS、PFS和pKPS方面非常接近成为主导技术。
Low-field intraoperative magnetic resonance (LF-iMR) has demonstrated a slight increase in the extent of resection of intra-axial tumors while preserving patient`s neurological outcomes. However, whether this improvement is cost-effective or not is still matter of controversy. In this clinical investigation we sought to evaluate the cost-effectiveness of the implementation of a LF-iMR in glioma surgery. Patients undergoing LF-iMR guided glioma surgery with gross total resection (GTR) intention were prospectively collected and compared to an historical cohort operated without this technology. Socio-demographic and clinical variables (pre and postoperative KPS; histopathological classification; Extent of resection; postoperative complications; need of re-intervention within the first year and 1-year postoperative survival) were collected and analyzed. Effectiveness variables were assessed in both groups: Postoperative Karnofsky performance status scale (pKPS); overall survival (OS); Progression-free survival (PFS); and a variable accounting for the number of patients with a greater than subtotal resection and same or higher postoperative KPS (R-KPS). All preoperative, procedural and postoperative costs linked to the treatment were considered for the cost-effectiveness analysis (diagnostic procedures, prosthesis, operating time, hospitalization, consumables, LF-iMR device, etc). Deterministic and probabilistic simulations were conducted to evaluate the consistency of our analysis. 50 patients were operated with LF-iMR assistance, while 146 belonged to the control group. GTR rate, pKPS, R-KPS, PFS, and 1-year OS were respectively 13,8% (not significative), 7 points (p < 0.05), 17% (p < 0.05), 38 days (p < 0.05), and 3.7% (not significative) higher in the intervention group. Cost-effectiveness analysis showed a mean incremental cost per patient of 789 € in the intervention group. Incremental cost-effectiveness ratios were 111 € per additional point of pKPS, 21 € per additional day free of progression, and 46 € per additional percentage point of R-KPS. Glioma patients operated under LF-iMR guidance experience a better functional outcome, higher resection rates, less complications, better PFS rates but similar life expectancy compared to conventional techniques. In terms of efficiency, LF-iMR is very close to be a dominant technology in terms of R-KPS, PFS and pKPS.