PARTIAL-BREAST IRRADIATION VERSUS WHOLE-BREAST IRRADIATION FOR EARLY-STAGE BREAST CANCER: A COST-EFFECTIVENESS ANALYSIS
PARTIAL-BREAST IRRADIATION VERSUS WHOLE-BREAST IRRADIATION FOR EARLY-STAGE BREAST CANCER: A COST-EFFECTIVENESS ANALYSIS
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DOI：
10.1016/j.ijrobp.2008.08.015
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发表时间：
2009-06-01
影响因子：
7
通讯作者：
Punglia, Rinaa S.
中科院分区：
文献类型：
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作者：
Sher, Davit J.;Wittenberg, Eve;Punglia, Rinaa S.
目的：加速局部乳腺照射(PBI)是治疗早期乳腺癌的一种新的治疗模式。虽然PBI可能会导致更高的局部复发率，但由于耐受性更好和成本更低，它可能是具有成本效益的。我们的目的是确定与全乳房放射治疗(WBRT)相比，早期乳腺癌绝经后雌激素受体阳性女性接受PBI治疗的增量成本-效果。方法和材料：我们建立了一个马尔可夫模型来描述早期乳腺癌放疗后15年的健康状况。外束(EB)和MammoSite(MS)PBI被认为是同样有效的，但成本不同。患者接受了他莫昔芬，但没有接受化疗。效用、复发风险和成本是根据文献改编的；放射治疗后无疾病的基线效用设定为0.92。概率敏感性分析被用来模拟PBI风险比、复发模式和患者效用的不确定性。结果：与EB-PBI相比，WBRT的增量成本-效果比为63万美元/质量调整生命年；WBRT在MS-PBI中占主导地位。单向敏感性分析发现，结果对PBI风险比、复发模式、基线复发风险以及没有疾病PBI效用值的证据敏感。概率敏感度显示，在广泛的假设和社会支付意愿价值的范围内，EB-PBI是最具成本效益的技术。结论：EB-PBI是绝经后早期乳腺癌患者最具成本效益的策略。除非MS-PBI后的生活质量被证明是优越的，否则它不太可能具有成本效益。(C)2009年爱思唯尔公司。
Purpose: Accelerated partial-breast irradiation (PBI) is a new treatment paradigm for patients with early-stage breast cancer. Although PBI may lead to greater local recurrence rates, it may be cost-effective because of better tolerability and lower cost. We aim to determine the incremental cost-effectiveness of PBI compared with whole-breast radiation therapy (WBRT) for estrogen receptor-positive postmenopausal women treated for early-stage breast cancer.Methods and Materials: We developed a Markov model to describe health states in the 15 years after radiotherapy for early-stage breast cancer. External beam (EB) and MammoSite (MS) PBI were considered and assumed to be equally effective, but carried different costs. Patients received tamoxifen, but not chemotherapy. Utilities, recurrence risks, and costs were adapted from the literature; the baseline utility for no disease after radiotherapy was set at 0.92. Probabilistic sensitivity analyses were performed to model uncertainty in the PBI hazard ratio, recurrence pattern, and patient utilities. Costs (in 2004 US dollars) and quality-adjusted life-years were discounted at 3%/y.Results: The incremental cost-effectiveness ratio for WBRT compared with EB-PBI was $630,000/quality-adjusted life-year; WBRT strongly dominated MS-PBI. One-way sensitivity analysis found that results were sensitive to PBI hazard ratio, recurrence pattern, baseline recurrence risk, and no evidence of disease PBI utility values. Probabilistic sensitivity showed that EB-PBI was the most cost-effective technique over a wide range of assumptions and societal willingness-to-pay values.Conclusions: EB-PBI was the most cost-effective strategy for postmenopausal women with early-stage breast cancer. Unless the quality of life after MS-PBI proves to be superior, it is unlikely to be cost-effective. (C) 2009 Elsevier Inc.