Long-term outcomes in virtual surgical planning for mandibular reconstruction: A cost-effectiveness analysis

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-06-29 DOI:10.1002/micr.31206

Lauren Gardiner MD, Brandon Smith MD, MS, Mark Kubik MD, Mario Solari MD, Kenneth Smith MD, John R. de Almeida MD, MSc, Shaum Sridharan MD

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引用次数: 0

Abstract

Objective

This study is an economic evaluation comparing virtual surgical planning (VSP) utilization to free hand mandibular reconstruction (FHR) for advanced oral cavity cancer, for which the cost effectiveness remains poorly understood. The proposed clinical benefits of VSP must be weighed against the additional upfront costs.

Methods

A Markov decision analysis model was created for VSP and FHR based on literature review and institutional data over a 35-year time horizon. Model parameters were derived and averaged from systematic review and institutional experience. VSP cost and surgical time saving was incorporated. We accounted for long-term risks including cancer recurrence and hardware failure/exposure. We calculated cost in US dollars and effectiveness in quality-adjusted-life-years (QALYs). A health care perspective was adopted, discounting costs and effectiveness at 3%/year. Deterministic and probabilistic sensitivity analyses tested model robustness.

Results

In the base case scenario, total VSP strategy cost was $49,498 with 8.37 QALYs gained while FHR cost was $42,478 with 8.27 QALY gained. An incremental cost-effectiveness ratio (ICER), or the difference in cost/difference in effectiveness, for VSP was calculated at $68,382/QALY gained. VSP strategy favorability was sensitive to variations of patient age at diagnosis and institutional VSP cost with one-way sensitivity analysis. VSP was less economically favorable for patients >75.5 years of age or for institutional VSP costs >$10,745. In a probabilistic sensitivity analysis, 55% of iterations demonstrated an ICER value below a $100,000/QALY threshold.

Conclusions/Relevance

VSP is economically favorable compared to FHR in patients requiring mandibular reconstruction for advanced oral cancer, but these results are sensitive to the patient's age at diagnosis and the institutional VSP cost. Our results do not suggest if one “should or should not” use VSP, rather, emphasizes the need for patient selection regarding which patients would most benefit from VSP when evaluating quality of life and long-term complications. Further studies are necessary to demonstrate improved long-term risk for hardware failure/exposure in VSP compared to FHR.

查看原文本刊更多论文

下颌骨重建虚拟手术规划的长期效果：成本效益分析。

研究目的本研究是一项经济评估，比较了晚期口腔癌虚拟手术规划（VSP）与徒手下颌骨重建（FHR）的使用情况。必须权衡虚拟手术规划的临床效益与额外的前期成本：方法：根据 35 年时间跨度内的文献综述和机构数据，为 VSP 和 FHR 建立了马尔可夫决策分析模型。模型参数根据系统回顾和医院经验得出并取平均值。其中包括 VSP 成本和手术时间的节省。我们考虑了长期风险，包括癌症复发和硬件故障/暴露。我们以美元计算成本，以质量调整生命年（QALYs）计算疗效。我们从医疗保健的角度出发，将成本和效果折现率定为 3%/年。确定性和概率敏感性分析检验了模型的稳健性：在基础方案中，VSP 策略的总成本为 49,498 美元，QALY 为 8.37，而 FHR 的成本为 42,478 美元，QALY 为 8.27。经计算，VSP 的增量成本效益比（ICER），即成本差异/疗效差异，为 68,382 美元/QALY gained。通过单向敏感性分析，VSP策略的有利性对患者诊断时的年龄和机构VSP成本的变化很敏感。如果患者年龄大于 75.5 岁或机构 VSP 费用大于 10,745 美元，则 VSP 的经济效益较低。在概率敏感性分析中，55%的迭代显示ICER值低于100,000美元/QALY阈值：对于因晚期口腔癌需要进行下颌骨重建的患者而言，VSP 与 FHR 相比具有经济上的优势，但这些结果对患者的诊断年龄和机构 VSP 成本很敏感。我们的研究结果并不建议 "应该或不应该 "使用 VSP，而是强调在评估生活质量和长期并发症时，需要对患者进行选择，以确定哪些患者最能从 VSP 中获益。有必要开展进一步研究，以证明与 FHR 相比，VSP 可改善硬件故障/暴露的长期风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.