What Treatment for Early-Stage Glottic Carcinoma Among Adult Patients: CO2 Endolaryngeal Laser Excision Versus Standard Fractionated External Beam Radiation Is Superior in Terms of Cost Utility?
What Treatment for Early-Stage Glottic Carcinoma Among Adult Patients: CO2 Endolaryngeal Laser Excision Versus Standard Fractionated External Beam Radiation Is Superior in Terms of Cost Utility?
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DOI：
10.1002/lary.21226
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发表时间：
2011-01-01
期刊：
影响因子：
2.6
通讯作者：
Higgins, Kevin M.
中科院分区：
文献类型：
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作者：
Higgins, Kevin M.
目的/假设：为了确定Tis/T1声门癌的治疗成人患者，经口CO2激光切除术（TOL）与外部光束辐射（XRT），是上级的成本utility.Study设计：成本效用analysis.Methods：6头对头比较研究和22个连续的病例系列被确定为检查肿瘤控制。将病例系列合并为复合组。主要终点为局部控制（LC）、无喉切除术生存期（LFS）和总生存期（OS）。客观和主观语音质量指标是次要终点。采用第三方支付者的视角进行成本效用分析。业务和资本成本采用微成本法确定。结果：TOL手术和XRT在LC（OR = 0.81，95%CI = 0.51-1.3）和LFS（OR = 0.84，95%CI = 0.42-1.66）方面无显著差异。OS的加权平均差异为0.03。语音质量的测量没有客观差异。采用平均5年局部对照初始概率进行决策树分析。CO2激光的成本为2475.65美元/例（2407.32美元/例），产生1.663个Qs，而辐射的成本为4965.85美元/例（4828.79美元/例），产生1.506个Qs。这对比了CO2激光（类似于1889美元/例，类似于1836.86美元/例）和放疗（类似于2454.70美元/例，类似于2386.95美元/例）的初始上游成本。结论：该荟萃分析表明，TOL手术和XRT之间的肿瘤结局没有明显差异。有一个趋势，改善治疗后的声音质量与XRT，虽然这是值得怀疑的临床意义。从成本效用的角度来看，TOL手术主导了XRT，主要是因为挽救治疗的下游可负担性增强。
Objectives/Hypothesis: To determine which treatment for Tis/T1 glottic carcinoma among adult patients, transoral CO2 laser excision (TOL) versus external beam radiation (XRT), is superior in terms of cost utility.Study Design: Cost-utility analysis.Methods: Six head-to-head comparison studies and 22 consecutive case series were identified to examine oncologic control. The case series were pooled as a composite group. Primary end points were local control (LC), laryngectomy-free survival (LFS), and overall survival (OS). Objective and subjective voice-quality measures were secondary end points. Third-party payer perspective was adopted for cost-utility analysis. Operational and capital costs were determined with the microcosting method. Rollback calculations and quality adjusted life years (QALYs) were calculated with decision-tree modeling.Results: There were no significant differences between TOL surgery and XRT with respect to LC (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.51-1.3) and LFS (OR, 0.84, 95% CI, 0.42-1.66). The weighted mean difference for OS was 0.03. There were no objective differences for measures of voice quality. Decision-tree analysis was undertaken using mean 5-year local control initial probabilities. CO2 laser cost $2475.65/case (US $2407.32/case), generating 1.663 QALYs, whereas radiation cost $4965.85/case (US $4828.79/case), generating 1.506 QALYs. This contrasts initial upstream costs for CO2 laser (similar to$1889/case, similar to US $1836.86/case) and radiation (similar to$2454.70/case, similar to US $2386.95/case).Conclusions: This meta-analysis shows that there is no clear difference in oncologic outcome between TOL surgery and XRT. There is a trend for improved post-treatment voice quality with XRT, although the clinical significance of this is questionable. TOL surgery dominates XRT from a cost-utility standpoint primarily because of the enhanced downstream affordability of salvage treatment.