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首页> 外文期刊>Urologic oncology >Modeling the cost of management options for stage I nonseminomatous germ cell tumors: a decision tree analysis Link RE, Allaf ME, Pili R, Kavoussi LR, James Buchanan Brady Urological Institute, Sidney Kimmel Comprehensive Cancer Center at Johns Hopki
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Modeling the cost of management options for stage I nonseminomatous germ cell tumors: a decision tree analysis Link RE, Allaf ME, Pili R, Kavoussi LR, James Buchanan Brady Urological Institute, Sidney Kimmel Comprehensive Cancer Center at Johns Hopki

机译：为I期非精原细胞性生殖细胞肿瘤的管理选择成本建模：决策树分析Link RE，Allaf ME，Pili R，Kavoussi LR，James Buchanan Brady泌尿外科研究所，Sidney Kimmel约翰霍普基综合癌症中心

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PURPOSE: Patients with clinical stage I nonseminomatous germ cell tumors (NSGCTs) have been managed with surveillance, chemotherapy, or retroperitoneal lymphadenectomy (RPLND) with similar survival outcomes. Cost factors influencing the choice of therapy were evaluated using computer-based decision analysis. METHODS: A detailed model was developed that integrates projected costs for more than 60 possible treatment outcomes. It incorporates primary, adjuvant, and salvage chemotherapy, primary and post-chemotherapy RPLND, and both laparoscopic and open surgical approaches. Starting values and probabilities were derived from a comprehensive meta-analysis of the last 25 years of testes cancer literature. Hypothesis testing was performed using sensitivity analysis. RESULTS: The model predicts a cost premium for both primary chemotherapy (18.7%) and RPLND (51.7%) compared with surveillance. If laparoscopic RPLND was practiced, the cost premium for primary surgery (29.1%) approached that of chemotherapy (26.4%). Open RPLND was 1.25x as costly as laparoscopic RPLND, primarily because of longer hospitalization. The choice of open RPLND yielded a 6.9% cost premium for a surveillance program in this model. For such a program, primary chemotherapy became cost advantageous when the probability of recurrence during surveillance was more than 46%. CONCLUSION: This model allows a variety of treatment cost hypotheses to be tested. Primary RPLND is never cost advantageous over surveillance or primary chemotherapy. Surgical costs can significantly increase the overall cost of a surveillance program. In stage I patients with high-risk tumor characteristics, primary chemotherapy may have a cost advantage over surveillance.
机译：目的：已通过监视，化学疗法或腹膜后淋巴结清扫术（RPLND）治疗具有临床I期非精原细胞性生殖细胞肿瘤（NSGCT）的患者，其生存结果相似。使用基于计算机的决策分析评估了影响治疗选择的成本因素。方法：开发了一个详细模型，该模型整合了60多种可能的治疗结果的预计成本。它结合了主要，辅助和挽救性化学疗法，主要和化学疗法RPLND以及腹腔镜和开放式手术方法。起始值和概率来自最近25年睾丸癌文献的综合荟萃分析。假设检验是使用敏感性分析进行的。结果：该模型预测与监测相比，原发化疗（18.7％）和RPLND（51.7％）的费用溢价。如果采用腹腔镜RPLND，则初次手术的费用溢价（29.1％）接近化学疗法的费用溢价（26.4％）。开放式RPLND的成本是腹腔镜RPLND的1.25倍，主要是因为住院时间更长。在这种模式下，选择开放式RPLND可使监视程序的成本溢价6.9％。对于这样的程序，当监测期间复发的可能性大于46％时，原发化疗变得成本优势。结论：该模型允许检验各种治疗费用假设。原发性RPLND永远不会比监测或原发性化疗具有成本优势。手术费用可能会大大增加监视程序的总体费用。在具有高危肿瘤特征的I期患者中，原发化疗可能比监测具有成本优势。

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