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Cost-effectiveness analysis of imaging surveillance in stage II and III extremity soft tissue sarcoma: an Australian perspective

机译：阶段II和III末端软组织赛萨马拉成本效益分析：澳大利亚观点

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Background:Surveillance imaging is used to detect local and/or distant recurrence following primary treatment of localised soft tissue sarcoma (STS), however evidence supporting optimal surveillance modality or frequency is lacking. We used prospectively collected sarcoma data to describe current surveillance imaging practice in patients with AJCC stage II and III extremity STS and evaluate its cost-effectiveness.Methods:From three selected Australian sarcoma referral centres, we identified patients with stage II and III extremity STS treated between 2009 and 2013. Medical records were reviewed to ascertain surveillance imaging practices, including modality, frequency and patient outcomes. A discrete event simulation model was developed and calibrated using clinical data to estimate health service costs and quality adjusted life years (QALYs) associated with alternative surveillance strategies.Results:Of 133 patients treated for stage II and III extremity STS, the majority were followed up with CT chest (86%), most commonly at 3-monthly intervals and 62% of patients had the primary site imaged with MRI at 6-monthly. There was limited use of chest-X-ray. A discrete event simulation model demonstrated that CT chest screening was the most cost effective surveillance strategy, gaining additional QALYs at a mean incremental cost of $30,743. MRI alone and PET-CT alone were not cost-effective, whilst a combined strategy of CT?+?MRI had an incremental cost per QALY gained of $96,556.Conclusions:Wide variations were observed in surveillance imaging practices in this high-risk STS cohort. Modelling demonstrated the value of CT chest for distant recurrence surveillance over other forms of imaging in terms of cost and QALYs. Further work is required to evaluate cost-effectiveness in a prospective manner.? The Author(s) 2020.
机译：背景：监测成像用于检测局部软组织Sarcoma（STS）的初次治疗后检测局部和/或远程复发，但是缺乏支持最佳监视的证据或频率。我们使用预期收集的SARCOMA数据来描述AJCC阶段II和III肢体STS患者的当前监测影像学实践，并评估其成本效益。方法：从三个选定的澳大利亚肉瘤转诊中心，我们鉴定了II期和III肢体STS治疗的患者在2009年至2013年期间。审查了医疗记录，以确定监测成像实践，包括模态，频率和患者结果。使用临床数据开发和校准了离散事件仿真模型，以估计与替代监测策略相关的卫生服务成本和质量调整的生命年份（QALYS）。结果：133名患者治疗II阶段和III肢体STS，大多数人进行了跟进患有CT胸部（86％），最常见的是3月间隔，62％的患者将主要部位每月与MRI成像。使用胸X射线有限。离散事件仿真模型表明CT胸部筛选是最具成本效益的监视策略，以30,743美元的平均增量成本获得额外的QALys。单独的MRI独自和PET-CT并不具有成本效益，而CT的组合策略（CT +）策略均为96,556美元的增量成本。结论：在这种高风险的STS队列中的监测成像实践中观察到广泛的变化。建模在成本和QALYS方面证明了CT胸的价值在其他形式的成像中进行了遥远的复发监测。需要进一步的工作来以前瞻性方式评估成本效益。作者2020年。

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