Economic Evaluation and Budget Impact Analysis of Indocyanine Green Test for Preoperative Liver Function in Patients with Major Hepatectomy in Thailand

IF 4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2025-08-22 DOI:10.1007/s12325-025-03341-1

Unchalee Permsuwan, Pajaree Sriuttha, Chutwichai Tovikkai, Anon Chotirosniramit, Asara Thepbunchonchai, Sunhawit Junrungsee, Worakitti Lapisatepun, Kittipong Chaiyabutr, Tharatip Srisuk, Piyameth Dilokthornsakul

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引用次数: 0

Abstract

Introduction

Post-hepatectomy liver failure (PHLF) remains a significant cause of morbidity and mortality following liver resections. Indocyanine green (ICG) clearance testing provides quantitative liver function assessment to improve perioperative risk stratification. However, its cost poses a concern in resource-limited settings like Thailand. This study aimed to evaluate the cost-utility and budget impact of adding ICG testing to standard diagnosis compared to standard diagnosis alone in patients undergoing first major hepatectomy.

Methods

A hybrid model combining a decision tree and Markov model was developed from a societal perspective over a lifetime horizon. Clinical data and cancer treatment costs were derived from 400 real-world patients admitted to four university hospitals. PHLF costs were sourced from the National Health Security Office and utility values were directly collected from patients admitted for major hepatectomy. Primary outcomes included total costs, life years, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). A 3% annual discount rate was applied. A variety of sensitivity analyses were conducted to test parameter uncertainty. A 5-year budget impact analysis was also performed from a payer’s perspective, calculating the net budget impact (NBI) between both strategies.

Results

Compared to standard diagnosis alone, adding ICG testing increased costs by 3600 Thai baht (THB) [102 US dollars ($)] and gained 0.001 QALYs, yielding an ICER of 2,763,973 THB/QALY ($78,321). The probability of cost-effectiveness at the ceiling threshold of 160,000 THB/QALY ($4,534) was 6.3%. The ICER would fall below this threshold if PHLF risk exceeded 10.1% or if ICG test cost decreased by at least 88%. The 5-year NBI was 39.5 million THB ($1.1 million), reduced by 47.3% with dose-sharing.

Conclusion

Although not cost-effective at current thresholds, ICG reduces PHLF-related costs and maintains an acceptable NBI per year.

查看原文本刊更多论文

泰国大肝切除术患者术前肝功能吲哚菁绿试验的经济评价和预算影响分析。

肝切除术后肝功能衰竭（PHLF）仍然是肝切除术后发病和死亡的重要原因。吲哚菁绿（ICG）清除率测试提供定量的肝功能评估，以改善围手术期风险分层。然而，在泰国等资源有限的国家，其成本令人担忧。本研究旨在评估首次肝切除术患者在标准诊断中加入ICG检测与单独标准诊断相比的成本效用和预算影响。方法：采用决策树模型和马尔可夫模型相结合的混合模型，从社会视角出发，建立了一种基于生命周期的决策树模型。临床数据和癌症治疗费用来自四所大学医院收治的400名现实世界患者。PHLF费用来自国家卫生安全办公室，效用值直接来自接受大肝切除术的患者。主要结局包括总成本、生命年、质量调整生命年（QALYs）和增量成本-效果比（ICER）。采用3%的年贴现率。进行了各种敏感性分析来测试参数的不确定度。还从付款人的角度进行了5年预算影响分析，计算了两种策略之间的净预算影响（NBI）。结果：与单独的标准诊断相比，增加ICG检测增加了3600泰铢（THB）（102美元）的费用，增加了0.001个QALY， ICER为2,763,973泰铢/QALY（78,321美元）。在160,000泰铢/QALY（4,534美元）的上限阈值下，成本效益的可能性为6.3%。如果PHLF风险超过10.1%或ICG测试成本降低至少88%，ICER将低于该阈值。5年NBI为3950万泰铢（110万美元），通过剂量共享减少了47.3%。结论：虽然在目前的阈值下不具有成本效益，但ICG降低了phlf相关的成本，并维持了每年可接受的NBI。

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

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.