{"title":"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。","authors":"Unchalee Permsuwan, Pajaree Sriuttha, Chutwichai Tovikkai, Anon Chotirosniramit, Asara Thepbunchonchai, Sunhawit Junrungsee, Worakitti Lapisatepun, Kittipong Chaiyabutr, Tharatip Srisuk, Piyameth Dilokthornsakul","doi":"10.1007/s12325-025-03341-1","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p><h3>Methods</h3><p>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.</p><h3>Results</h3><p>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.</p><h3>Conclusion</h3><p>Although not cost-effective at current thresholds, ICG reduces PHLF-related costs and maintains an acceptable NBI per year.</p></div>","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":"42 10","pages":"5202 - 5214"},"PeriodicalIF":4.0000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12325-025-03341-1.pdf","citationCount":"0","resultStr":"{\"title\":\"Economic Evaluation and Budget Impact Analysis of Indocyanine Green Test for Preoperative Liver Function in Patients with Major Hepatectomy in Thailand\",\"authors\":\"Unchalee Permsuwan, Pajaree Sriuttha, Chutwichai Tovikkai, Anon Chotirosniramit, Asara Thepbunchonchai, Sunhawit Junrungsee, Worakitti Lapisatepun, Kittipong Chaiyabutr, Tharatip Srisuk, Piyameth Dilokthornsakul\",\"doi\":\"10.1007/s12325-025-03341-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>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.</p><h3>Methods</h3><p>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.</p><h3>Results</h3><p>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.</p><h3>Conclusion</h3><p>Although not cost-effective at current thresholds, ICG reduces PHLF-related costs and maintains an acceptable NBI per year.</p></div>\",\"PeriodicalId\":7482,\"journal\":{\"name\":\"Advances in Therapy\",\"volume\":\"42 10\",\"pages\":\"5202 - 5214\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2025-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://link.springer.com/content/pdf/10.1007/s12325-025-03341-1.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Advances in Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://link.springer.com/article/10.1007/s12325-025-03341-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Therapy","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s12325-025-03341-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
Economic Evaluation and Budget Impact Analysis of Indocyanine Green Test for Preoperative Liver Function in Patients with Major Hepatectomy in Thailand
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.
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.
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