Is Improved Survival in Early-Stage Pancreatic Cancer Worth the Extra Cost at High-Volume Centers?
Is Improved Survival in Early-Stage Pancreatic Cancer Worth the Extra Cost at High-Volume Centers?
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DOI：
10.1016/j.jamcollsurg.2021.02.014
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发表时间：
2021-07
影响因子：
5.2
通讯作者：
Hoch JS
中科院分区：
文献类型：
--
作者：
Perry LM;Bateni SB;Bold RJ;Hoch JS
手术例数的增加可能是早期胰腺癌患者生存率提高的一个重要因素。大多数高容量的胰腺中心也是学术机构，这与额外的医疗成本有关。我们假设，在大容量中心，额外生存的价值大于额外成本。这项回溯性队列研究使用了加州癌症登记处从2004年1月1日到2012年12月31日期间与全州卫生规划和发展办公室数据库链接的数据。包括接受切除的I-II期胰腺癌患者。多变量分析估计了低容量胰腺手术中心与大容量胰腺手术中心的总存活率和30天成本。估算增量成本-效果比(ICER)和增量净效益(INB)，并用净效益回归分析统计不确定性。在2786名患者中，46.5%在高容量中心接受治疗，53.5%在低容量中心接受治疗。有0.45年(5.4个月)的生存收益(95%可信区间0.21-0.69)和在大容量中心接受手术相关的额外成本7884美元(95%可信区间为4074-11694美元)。多存活一年的ICER为17,529美元(95%CI为7,997-40,616美元)。对于愿意为多一年的寿命支付2万美元以上的决策者来说，大容量中心似乎是划算的。尽管大容量中心的医疗费用更高，但在大容量中心接受胰腺手术的患者获得了生存优势(5.4个月)。每多一年17,529美元的额外成本对于提高存活率来说是相当温和的，而且按照许多肿瘤学标准来看，在经济上是有吸引力的。
Volume of operative cases may be an important factor associated with improved survival for early-stage pancreatic cancer. Most high-volume pancreatic centers are also academic institutions, which have been associated with additional healthcare costs. We hypothesized that at high-volume centers, the value of the extra survival outweighs the extra cost. This retrospective cohort study used data from the California Cancer Registry linked to the Office of Statewide Health Planning and Development database from January 1, 2004 through December 31, 2012. Stage I-II pancreatic cancer patients who underwent resection were included. Multivariable analyses estimated overall survival and 30-day costs at low- vs high-volume pancreatic surgery centers. The incremental cost-effectiveness ratio (ICER) and incremental net benefit (INB) were estimated, and statistical uncertainty was characterized using net benefit regression. Of 2,786 patients, 46.5% were treated at high-volume centers and 53.5% at low-volume centers. There was a 0.45-year (5.4 months) survival benefit (95% CI 0.21–0.69) and a $7,884 extra cost associated with receiving surgery at high-volume centers (95% CI $4,074–$11,694). The ICER was $17,529 for an additional year of survival (95% CI $7,997–$40,616). For decision-makers willing to pay more than $20,000 for an additional year of life, high-volume centers appear cost-effective. Although healthcare costs were greater at high-volume centers, patients undergoing pancreatic surgery at high-volume centers experienced a survival benefit (5.4 months). The extra cost of $17,529 per additional year is quite modest for improved survival and is economically attractive by many oncology standards.
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