动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析

李仕来; 万裴琦; 彭涛; 肖开银; 苏铭; 尚丽明; 徐邦浩; 苏智雄; 叶新平; 彭宁; 黎乐群

doi:10.3971/j.issn.1000-8578.2015.04.007

动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析

530021 南宁，广西医科大学第一附属医院肝胆外科

基金项目: 国家自然科学基金（81160262）

详细信息

作者简介:
李仕来（1981-），男，博士，主治医师，主要从事肝癌复发与转移的研究

通讯作者:
黎乐群，E-mail：li_lequn@263.net

中图分类号: R735.7
计量
- 文章访问数: 1516
- HTML全文浏览量: 343
- PDF下载量: 37929
出版历程
- 收稿日期: 2014-12-01
- 修回日期: 2015-02-08
- 刊出日期: 2015-04-24

Cost Effectiveness of Transcatheter Arterial Chemoembolization for Preventing Hepatocellular Carcinoma Recurrence After Radical Resection

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China

摘要

摘要: 目的建立肝细胞癌（简称肝癌）根治性切除术后预防性动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）治疗的卫生经济学评价模型。方法 140例肝癌患者根治性切除术后分为TACE组和非TACE组（即门诊随访组），收集两组治疗方案直接医疗成本和治疗效果（复发率及无瘤生存时间），进行成本效果分析、增量成本效果分析和敏感度分析。结果（1）40例非TACE组患者门诊总平均费用为7 121.44元/人；100例TACE组患者复发前总费用为2 8250.45元/人。（2）非TACE组和TACE组的1、2、3、4、5年复发率比较差异无统计学意义（P＞0.05）；两组无瘤生存时间比较差异无统计学意义（P=0.322）。（3）非TACE组的成本效果比为389.15元/月，TACE组为1 278.30元/月，增量成本效果比为5 560.27元/月。（4）敏感度分析中非TACE组的成本度效果比为350.84元/月，TACE组为1 215.81元/月，增量成本效果比为5 381.35元/月。结论从卫生经济学角度，预防肝癌术后复发，预防性TACE并不是最优方案，至少不是每个患者都应该或都适合做，在相同的效果下（复发率、无瘤生存时间）门诊随访治疗可能更经济。
- 动脉化疗栓塞术（TACE） /
- 肝细胞癌 /
- 复发 /
- 卫生经济学 /
- 成本效果分析
Abstract: Objective To establish the health economics evaluation model of preventative transcatheter arterial chemoembolization(TACE) on hepatocellular carcinoma(HCC) patients after radical resection. Methods A total of 140 HCC patients were divided into TACE group and non-TACE group after radical resection. In TACE group, TACEs were performed; and in non-TACE group, only follow-up visits through outpatient department were performed. Direct medical costs of two groups were collected. Recurrent rate and tumor free survival were picked up as effectiveness. Then cost effectiveness and incremental cost effectiveness were analyzed. At last, the sensitivity analysis was also conducted. Results (1) In non-TACE group, the average cost for the outpatient care was 7 121.44 yuan per patient. Meanwhile, in TACE group, the total cost was 2 8250.45 yuan per patient before tumor recurrences. (2) The tumor free survival rates for 1, 2, 3, 4, 5 years between non-TACE group and TACE group were similar, without significant difference(P＞0.05).And the tumor free survivals were also similar between two groups (P=0.322). (3) The cost effectiveness ratio was 389.15 yuan/month in non-TACE group while 1 278.30 yuan/month in TACE group. And the incremental cost effectiveness ratio was 5 560.27 yuan/month. (4) According to the sensitivity analysis, the cost effectiveness ratio was 350.84 yuan/month in non-TACE group while 1 215.81 yuan/month in TACE group. And the incremental cost effectiveness ratio was 5 381.35 yuan/month. Conclusion According to the health economics, the preventative treatment of TACE after radical resection for HCC patients is not the best choice, at least is not suitable for every case. It seems that the outpatient care is more economic under the similar effectiveness, recurrent rate and tumor free survival.
- Transcatheter arterial chemoembolization(TACE) /
- Hepatocellular carcinoma /
- Recurrence /
- Health economics /
- Cost effectiveness analysis

HTML全文

参考文献(19)

[1]	Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer, 2015, 136(5): E359-86.
[2]	Chen WQ, Zhang SW, Zeng HM, et al. Report of cancer incidence and mortality in China, 2010[J]. Zhongguo Zhong Liu, 2014, 23 (1): 1-10. [陈万青, 张思维, 曾红梅, 等. 中国2010年恶性肿瘤发病与死亡[J]. 中国肿瘤, 2014, 23(1): 1-10.]
[3]	Gao GY. Health economics analysis of typical cases[M]. Beijing: People Health Publishing House, 2011, 1. [高广颖. 卫生经济学典型案例分析[M]. 北京: 人民卫生出版社, 2011, 1.]
[4]	Zhou XD. Recurrence and metastasis of hepatocellular carcinoma: progress and prospects[J]. Hepatobiliary Pancreat Dis Int, 2002, 1( 1): 35-41.
[5]	Sun HC, Tang ZY. Preventive treatments for recurrence after curative resection of hepatocellular carcinoma--a literature review of randomized control trials[J]. World J Gastroenterol, 2003, 9(4): 63 5-40.
[6]	Chen XH, Zhang BH, Qiu SJ, et al. Effect of postoperative adjuvant transarterial chemoembolization on late recurrence of hepatocellular carcinoma after radical resection[J]. Zhonghua Gan Zang Bing Za Zhi, 2010, 18(8): 599-603. [陈晓泓, 张博恒, 邱双健, 等. 肝细胞癌根治术后辅助性肝动脉化疗栓塞对远期复发的影响[J]. 中华肝脏病杂志, 2010, 18(8): 599-603.]
[7]	Shen L, Zhu HC, Huang JF, et al. Survival analysis of 108 cases with advanced primary liver cancer treated by transcatheter arterial chemoembolization[J]. Zhong Liu Fang Zhi Yan Jiu, 2011, 38(10): 11 63-6.[沈玲, 朱海超, 黄建锋, 等. TACE治疗中晚期原发性肝癌108例生存分析[J]. 肿瘤防治研究, 2011, 38(10): 1163-6.]
[8]	Chen XH, Zhang BH, Qiu SJ, et al. Effect of postoperative adjuvant transarterial chemoembolization upon early recurrence after radical resection of hepatocellular carcinoma[J]. Zhonghua Gan Zang Bing Za Zhi, 2010, 90(12): 826-9. [陈晓泓, 张博恒, 邱双健, 等. 肝细胞癌根治术后辅助性肝动脉化疗栓塞对近期复发的影响[J]. 中华肝脏病杂志, 2010, 90(12): 826-9.]
[9]	Ministry of Health of the People's Republic of China ([2011]121). Primary liver cancer diagnosis and treatment standard (2011 Edition)[J]. Lin Chuang Zhong Liu Xue Za Zhi, 2011, 16(10): 92 9-46. [中华人民共和国卫生部. 原发性肝癌诊疗规范（2011 年版） [J]. 临床肿瘤学杂志, 2011, 16(10): 929-46.]
[10]	Gao GY. Health economics analysis of typical cases[M]. Beijing: People Health Publishing House, 2011: 258. [高广颖. 卫生经济学典型案例分析[M]. 北京: 人民卫生出版社, 2011: 258.]
[11]	Gu H, Li HC. Study of the related problems in the application of the cost-effectiveness analysis in pharmacoeconomics[J]. Zhongguo Yao Fang, 2004, 15(11): 674-6. [顾海, 李洪超. 药物经济学成本-效果分析应用的相关问题探讨[J]. 中国药房, 2004, 15(11): 674-6.]
[12]	Gao GY. Health economics analysis of typical cases[M]. Beijing: People Health Publishing House, 2011: 259. [高广颖. 卫生经济学典型案例分析[M]. 北京: 人民卫生出版社, 2011: 259.]
[13]	Gunay Y, Guler N, Akyildiz M, et al. Management of patients with recurrent hepatocellular carcinoma following living donor liver transplantation: a single center experience[J]. Gulf J Oncolog, 20 14, 1(15): 12-8 .
[14]	Ercolani G, Grazi GL, Ravaioli M, et al. Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence[J]. Ann Surg, 20 03, 237(4): 536-43 .
[15]	Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome[J]. Liver Transpl, 20 04, 10(2 Suppl 1): S39-45 .
[16]	Jiang QC, Li SH. Health economics courses[M]. Hefei: Anhui Science and Technology Publishing House, 2002: 266-86. [江启成, 李绍华. 卫生经济学教程[M]. 合肥: 安徽科学技术出版社, 20 02: 266-86.]
[17]	Liu Q. Analysis of commonly used evaluation methods of medical economics[J]. Zhongguo Xian Dai Yi Xue Za Zhi, 2009, 19(12): 19 13-5. [刘勤. 卫生经济学常用评价方法浅析[J]. 中国现代医学杂志, 2009, 19(12): 1913-5.] .
[18]	Liu B, Zhao ZQ, Wang LL, et al. Forward evaluations of CBA in health economics[J]. Zhongguo Wei Sheng Jing Ji, 2006, 6(25): 75 -6. [刘柏, 赵振全, 汪玲丽, 等. 卫生经济成本效果分析的前沿评价方法研究[J]. 中国卫生经济, 2006, 6(25): 75-6.]
[19]	Gao GY. Health economics analysis of typical cases[M]. Beijing: People Health Publishing House, 2011: 262. [高广颖. 卫生经济学典型案例分析[M]. 北京: 人民卫生出版社, 2011: 262.]

施引文献

资源附件(0)

计量

文章访问数: 1516
HTML全文浏览量: 343
PDF下载量: 37929
被引次数: 0

动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析

作者简介:
李仕来（1981-），男，博士，主治医师，主要从事肝癌复发与转移的研究

通讯作者:
黎乐群，E-mail：li_lequn@263.net

计量

Cost Effectiveness of Transcatheter Arterial Chemoembolization for Preventing Hepatocellular Carcinoma Recurrence After Radical Resection

计量

目录

下载中心

友情链接

联系我们

动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析

作者简介: 李仕来（1981-），男，博士，主治医师，主要从事肝癌复发与转移的研究

通讯作者: 黎乐群，E-mail：li_lequn@263.net

计量

出版历程

Cost Effectiveness of Transcatheter Arterial Chemoembolization for Preventing Hepatocellular Carcinoma Recurrence After Radical Resection

计量

出版历程

目录

下载中心

友情链接

联系我们

作者简介:
李仕来（1981-），男，博士，主治医师，主要从事肝癌复发与转移的研究

通讯作者:
黎乐群，E-mail：li_lequn@263.net