Cost modeling of preoperative axillary ultrasound and fine-needle aspiration to guide surgery for invasive breast cancer.
Cost modeling of preoperative axillary ultrasound and fine-needle aspiration to guide surgery for invasive breast cancer.
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DOI：
10.1245/s10434-010-0919-1
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发表时间：
2010-04
影响因子：
3.7
通讯作者：
Long KH
中科院分区：
文献类型：
--
作者：
Boughey JC;Moriarty JP;Degnim AC;Gregg MS;Egginton JS;Long KH
术前腋窝淋巴结超声（US）和细针穿刺（FNA）活检可以识别一定比例的淋巴结阳性患者，避免前哨淋巴结（SLN）手术和直接手术治疗。我们比较了浸润性乳腺癌术前US/FNA与无US/FNA（标准护理）的成本。使用决策分析软件，我们构建了一个模型来评估与两种术前策略相关的成本。从文献综述中获得诊断试验的敏感性和特异性。费用来自医疗保险支付率和实际资源利用率。基本情况结果是完全概率性的，以捕捉经济结果中的参数不确定性。基础病例结果估计，US/FNA策略每例患者的总平均成本为10，947美元（“$”表示美元），标准治疗为10，983美元，平均每例患者的增量成本节省为36美元[成本差异的95%置信区间（CI）：-248至179美元]。大多数（63%）的模拟结果显示腋窝US/FNA可节省成本。单向敏感性分析表明，结果是敏感的假设诊断和手术费用和选定的诊断测试参数。US/FNA方法相对于所有肿瘤分期的标准治疗在成本或成本节约方面相似。在每个患者中进行腋窝US和可能的FNA的额外成本被平均平衡，因为在术前可以记录转移的情况下避免SLN可以节省成本。常规使用术前腋窝超声和细针穿刺引导手术计划可以降低浸润性乳腺癌患者护理的总体成本。
Preoperative axillary lymph node ultrasound (US) and fine-needle aspiration (FNA) biopsy can identify a proportion of node-positive patients and avoid sentinel lymph node (SLN) surgery and direct surgical treatment. We compared the costs with preoperative US/FNA to without US/FNA (standard of care) for invasive breast cancer. Using decision-analytic software we constructed a model to assess the costs associated with the two preoperative strategies. Diagnostic test sensitivities and specificities were obtained from literature review. Costs were derived from Medicare payment rates and actual resource utilization. Base-case results were fully probabilistic to capture parameter uncertainty in economic results. Base-case results estimate total mean costs per patient of $10,947 (“$” indicates US dollars throughout) with the US/FNA strategy and $10,983 with standard of care, an incremental cost savings of $36, on average, per patient [95% confidence interval (CI) of cost difference: −$248 to $179]. Most (63%) of the simulations resulted in cost saving with axillary US/FNA. One-way sensitivity analyses suggest that results are sensitive to assumed diagnostic and surgical costs and selected diagnostic test parameters. US/FNA approach was similar in costs or cost saving relative to the standard of care for all tumor stages. The additional cost of performing axillary US with possible FNA in every patient is balanced, on average, by the savings from avoiding SLN in cases where metastasis can be documented preoperatively. Routine use of preoperative axillary US with FNA to guide surgical planning can decrease the overall cost of patient care for invasive breast cancer.
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影响因子：
19.7
作者：
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通讯作者：
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