A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases
A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases
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DOI：
10.1016/s0360-3016(97)00071-0
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发表时间：
1997-09-01
影响因子：
7
通讯作者：
Kinsella, T
中科院分区：
文献类型：
--
作者：
Mehta, M;Noyes, W;Kinsella, T
目的：尽管尚未对这两种治疗方式进行随机试验，但经过精心选择的单脑转移瘤患者接受全脑放疗和切除术或放射外科治疗的中位生存期相当。在这个成本控制的时代，医疗保健专业人员必须做出谨慎的决定。目前的环境需要一个明显的等效治疗方式的关键评价，它是在这种情况下，我们提出了切除和放射外科治疗脑转移瘤的实际成本的比较。方法和材料：从两项随机试验中获得了单独放疗或手术治疗的生存率和生活质量结果数据，放射外科结果来自多机构分析，专门评估符合手术标准的患者。仅考虑了直线加速器放射外科数据。从社会的角度进行了成本分析，并对以下参数进行了评价：实际成本、成本比率、成本效益、增量成本效益、成本效用、增量成本效用和国家成本负担。我们回顾了1989年1月至1994年7月间所有接受切除术或放射外科治疗的单发脑转移瘤患者的计算机计费记录。共进行了46次切除和135次放射外科手术。在同一时期，454名患者接受了全脑放疗。对每一个程序的整个账单进行了分析，并为每一个分项费用分配了一个比例数字。使用Wilcoxon秩和检验比较切除术和放射外科手术的相对成本比。每种治疗方式的成本效益，定义为中位生存期每年的成本，进行了评价。还确定了增量成本效益，定义为与下一个最便宜的方式相比，中位生存率每年增加的额外成本。为了计算这些做法的社会或国家的影响，估计的比例可能有资格积极的管理患者和财政影响是确定使用各种利用率为radiosurgery和surgery.Results：无论是切除和radiosurgery取得了上级生存和功能的独立性，相比，全脑放疗单独，与两种方式之间的结果略有差异;与放射外科相比，切除导致成本增加1.8倍。即使进行高达50%的敏感性分析，后一种方式在所有指标上都产生了上级成本结果。反向估计表明，为了使手术产生相等的成本效益，其成本必须降低48%，或者中位生存率必须提高108%。平均每周生存成本为放疗310美元，切除加放疗524美元，放射外科加radiosurgery.Conclusions：对于选定的患者，积极的策略，如切除或放射外科手术是必要的，因为它们会导致改善中位生存和功能的独立性。放射外科似乎是更具成本效益的程序。(C)1997年爱思唯尔科学公司
Purpose: The median survival of well-selected patients with single-brain metastases treated with whole-brain irradiation and resection or radiosurgery is comparable, although a randomized trial of these two modalities has not been performed. In this era of cost containment, it is imperative that health-care professionals make fiscally prudent decisions. The present environment necessitates a critical appraisal of apparently equi-efficacious therapeutic modalities, and it is within this context that we present a comparison of the actual costs of resection and radiosurgery for brain metastases.Methods and Materials: Survival and quality of life outcome data for radiation alone or with surgery were obtained from two randomized trials, and radiosurgical results were obtained from a multiinstitutional analysis that specifically evaluated patients meeting surgical criteria. Only linear accelerator radiosurgery data were considered. Cost analysis was performed from a societal view point, and the following parameters were evaluated: actual cost, cost ratios, cost effectiveness, incremental cost effectiveness, cost utility, incremental cost utility, and national cost burden. The computerized billing records for all patients undergoing resection or radiosurgery for single-brain metastases from January 1989 to July 1994 were reviewed. A total of 46 resections and 135 radiosurgery procedures were performed. During the same time period, 454 patients underwent whole-brain radiation alone. An analysis of the entire bill was performed for each procedure, and each itemized cost was assigned a proportionate figure. The relative cost ratios of resection and radiosurgery were compared using the Wilcoxon rank sum test. Cost effectiveness of each modality, defined as the cost per year of median survival, was evaluated. Incremental cost effectiveness, defined as the additional cost per year of incremental gain in median survival, compared to the next least expensive modality, was also determined. To calculate the societal or national impact of these practices, the proportion of patients potentially eligible for aggressive management was estimated and the financial impact was determined using various utilization ratios for radiosurgery and surgery.Results: Both resection and radiosurgery yielded superior survival and functional independence, compared to whole brain radiotherapy alone, with minor differences in outcome between the two modalities; resection resulted in a 1.8-fold increase in cost, compared to radiosurgery, The latter modality yielded superior cost outcomes on all measures, even when a sensitivity analysis of up to 50% was performed. A reversal estimate indicated that in order for surgery to yield equal cost effectiveness, its cost would have to decrease by 48% or median survival would have to improve by 108%. The average cost per week of survival was $310 for radiotherapy, $524 for resection plus radiation, and $270 for radiosurgery plus radiation.Conclusions: For selected patients, aggressive strategies such as resection or radiosurgery are warranted, as they result in improved median survival and functional independence. Radiosurgery appears to be the more cost-effective procedure. (C) 1997 Elsevier Science Inc.