Comparative effectiveness and cost-effectiveness of endoscopic nasopharyngectomy versus intensity-modulated radiotherapy in the treatment of recurrent nasopharyngeal carcinoma: A microsimulation analysis.

IF 2.3 3区 医学 Q1 OTORHINOLARYNGOLOGY
Mingjun Rui, Yingcheng Wang
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引用次数: 0

Abstract

Background: Nasopharyngeal carcinoma (NPC) is a significant health concern in southern China, like Guangdong and Hong Kong. This study aims to predict the effectiveness and cost-effectiveness of two prevalent NPC treatments, intensity-modulated radiotherapy (IMRT) and endoscopic nasopharyngectomy (ENPG).

Methods: A microsimulation model was developed to project the long-term outcomes of IMRT and ENPG, simulating 5000 patients with hypothetical locally recurrent NPC for each treatment option. The tumors of patients confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Analyses were performed from the healthcare system perspectives of Mainland China and the healthcare provider perspective of Hong Kong, with input parameters sourced from the existing literature and databases. The robustness of findings was evaluated through one-way and probabilistic sensitivity analyses.

Results: For DFS, ENPG showed a 29% reduction in risk with an HR of 0.71 (95% CI: 0.64-0.77) compared to IMRT. ENPG demonstrated a significant survival benefit in OS with an HR of 0.59 (95% CI: 0.54-0.65), equating to a 41% reduction in mortality risk. In Hong Kong, IMRT and ENPG yielded QALY gains of 4.59 and 6.29, respectively, with ENPG exhibiting an incremental cost-effectiveness ratio (ICUR) of USD 13 057 per QALY. For Mainland China, ENPG denominated the IMRT and the ICUR was USD -1450 QALY. Probabilistic sensitivity analysis showed a 100% probability of ENPG being cost-effective at the willingness-to-pay thresholds of USD 130 490 per QALY in Hong Kong and USD 12 741 per QALY in Mainland China.

Conclusion: The analysis confirms that ENPG is more effective and cost-effective than IMRT for treating recurrent NPC in both Hong Kong and Mainland China.

治疗复发性鼻咽癌的内窥镜鼻咽切除术与调强放射治疗的有效性和成本效益比较:微观模拟分析。
背景:鼻咽癌(NPC)是华南地区(如广东和香港)的一个重大健康问题。本研究旨在预测两种流行的鼻咽癌治疗方法--调强放射治疗(IMRT)和内窥镜鼻咽切除术(ENPG)的有效性和成本效益:我们开发了一个微观模拟模型来预测调强放射治疗(IMRT)和内窥镜鼻咽切除术(ENPG)的长期疗效,模拟了 5000 名假定局部复发性鼻咽癌患者接受每种治疗方案的情况。患者的肿瘤局限于鼻咽腔、后鼻孔或鼻中隔、浅咽旁间隙或蝶窦基底壁。分析从中国大陆医疗系统和香港医疗机构的角度进行,输入参数来自现有文献和数据库。通过单向和概率敏感性分析评估了研究结果的稳健性:就 DFS 而言,与 IMRT 相比,ENPG 降低了 29% 的风险,HR 值为 0.71(95% CI:0.64-0.77)。ENPG在OS方面显示出明显的生存优势,HR为0.59(95% CI:0.54-0.65),相当于将死亡风险降低了41%。在香港,IMRT和ENPG的QALY收益分别为4.59和6.29,ENPG的增量成本效益比(ICUR)为每QALY 13 057美元。在中国大陆,ENPG以IMRT为单位,ICUR为-1450美元每QALY。概率敏感性分析显示,在香港每QALY 130 490美元和中国大陆每QALY 12 741美元的支付意愿阈值下,ENPG具有成本效益的概率为100%:分析证实,在香港和中国大陆,ENPG治疗复发性鼻咽癌比IMRT更有效、更具成本效益。
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
CiteScore
7.00
自引率
6.90%
发文量
278
审稿时长
1.6 months
期刊介绍: Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.
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