直肠癌的全面新辅助治疗与传统新辅助治疗:公共卫生系统的成本分析。

IF 1.6 4区 医学 Q3 SURGERY
Ishraq Murshed, Sergei Bedrikovetski, Ishmam Murshed, Zachary Bunjo, Tracy Fitzsimmons, Michelle Thomas, Tarik Sammour
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引用次数: 0

摘要

目的:全面新辅助治疗(TNT)已成为局部晚期直肠癌的标准治疗方法,但其经济影响尚不清楚。这项研究比较了TNT与传统新辅助治疗(CNT)的成本,包括短期放疗或长期放化疗,在一个普遍资助的公共卫生系统中。方法:根据CHEERS的指导方针,从第三方付款人的角度进行了基于试验的成本分析,时间跨度为2年。从多机构数据库中提取2014年至2023年连续接受新辅助治疗的直肠癌患者。提取住院、门诊、影像、病理资源成本,调整为2024澳元,折扣率5%。主要结局是每个队列的总成本和每个患者的平均成本。次要结局是每个成本类别的总成本和平均成本。敏感性分析探讨了贴现率和通货膨胀方法的影响。结果:115例符合条件的患者中,60例(52.2%)接受了CNT治疗,55例(47.8%)接受了TNT治疗。队列的总治疗费用为8429710.66美元(CNT)和6929616.67美元(TNT),平均每位患者费用为140495.18美元(CNT)和127138.48美元(TNT)。TNT患者的总体每位患者成本较低13 356.70美元(9.51%),主要是由于平均住院成本较低(78 523.53美元对96 843.08美元,18.9%)。TNT增加了门诊费用(43 001.18美元对39 376.12美元,9.21%)、影像学费用(4179.13美元对2973.61美元,40.5%)和病理费用(1434.65美元对1302.38美元,10.1%)。结果对敏感性分析具有稳健性。结论:在普遍资助的公共医疗保健系统中,TNT比CNT成本更低,主要是因为住院费用降低,器官保存率更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Therapy for Rectal Cancer: Cost Analysis in a Public Healthcare System.

Purpose: Total neoadjuvant therapy (TNT) has become the standard of care in locally advanced rectal cancer, but its economic impact is unclear. This study compares the cost of TNT with conventional neoadjuvant therapy (CNT), consisting of either short-course radiotherapy or long-course chemoradiotherapy, within a universally funded public healthcare system.

Methodology: A trial-based costing analysis was conducted from a third-party payer's perspective with a 2-year time horizon, following CHEERS guidelines. Consecutive patients with rectal cancer treated with neoadjuvant therapy from 2014 to 2023 were extracted from a multi-institutional database. Inpatient, outpatient, imaging and pathology resource costs were extracted and adjusted to 2024 AUD with a 5% discount rate. Primary outcomes were overall cost per cohort and mean per patient cost. Secondary outcomes were overall and mean cost per cost category. Sensitivity analysis explored the influence of discount rates and inflation methods.

Results: Of 115 eligible patients, 60 (52.2%) received CNT and 55 (47.8%) received TNT. Overall treatment costs for the cohorts were $8 429 710.66 (CNT) and $6 992 616.67 (TNT), with mean per patient costs of $140 495.18 (CNT) and $127 138.48 (TNT). Overall per patient costs were $13 356.70 (9.51%) lower for TNT patients, mainly driven by lower mean inpatient costs ($78 523.53 vs. $96 843.08, 18.9%). TNT increased outpatient ($43 001.18 vs. $39 376.12, 9.21%), imaging ($4179.13 vs. $2973.61, 40.5%) and pathology ($1434.65 vs. $1302.38, 10.1%) costs. The results were robust to sensitivity analysis.

Conclusion: TNT is less costly than CNT within a universally funded public healthcare system, primarily due to reduced inpatient costs associated with higher rates of organ preservation.

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来源期刊
ANZ Journal of Surgery
ANZ Journal of Surgery 医学-外科
CiteScore
2.50
自引率
11.80%
发文量
720
审稿时长
2 months
期刊介绍: ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
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