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经肝动脉化疗栓塞术中应用三氧化二砷载药微球与三氧化二砷碘化油治疗不可切除原发性肝癌的成本效益分析

王文辉 段旭华 李浩 琚书光 王满周 任建庄 韩新巍

王文辉, 段旭华, 李浩, 等. 经肝动脉化疗栓塞术中应用三氧化二砷载药微球与三氧化二砷碘化油治疗不可切除原发性肝癌的成本效益分析[J]. 临床肝胆病杂志, 2021, 37(9): 2125-2129. DOI: 10.3969/j.issn.1001-5256.2021.09.024
引用本文: 王文辉, 段旭华, 李浩, 等. 经肝动脉化疗栓塞术中应用三氧化二砷载药微球与三氧化二砷碘化油治疗不可切除原发性肝癌的成本效益分析[J]. 临床肝胆病杂志, 2021, 37(9): 2125-2129. DOI: 10.3969/j.issn.1001-5256.2021.09.024
WANG WH, DUAN XH, LI H, et al. A cost-effect analysis of transarterial chemoembolization with CalliSpheres beads loaded with arsenic trioxide versus arsenic trioxide iodized oil emulsion in treatment of unresectable liver cancer[J]. J Clin Hepatol, 2021, 37(9): 215-2129. DOI: 10.3969/j.issn.1001-5256.2021.09.024
Citation: WANG WH, DUAN XH, LI H, et al. A cost-effect analysis of transarterial chemoembolization with CalliSpheres beads loaded with arsenic trioxide versus arsenic trioxide iodized oil emulsion in treatment of unresectable liver cancer[J]. J Clin Hepatol, 2021, 37(9): 215-2129. DOI: 10.3969/j.issn.1001-5256.2021.09.024

经肝动脉化疗栓塞术中应用三氧化二砷载药微球与三氧化二砷碘化油治疗不可切除原发性肝癌的成本效益分析

DOI: 10.3969/j.issn.1001-5256.2021.09.024
基金项目: 

中国健康促进基金会 XM_2018_011_0006_01

河南省重点研发与推广专项(科技攻关)项目 202102310462

详细信息
    通讯作者:

    段旭华,xuhuaduan@163.com

  • 中图分类号: 735.7

A cost-effect analysis of transarterial chemoembolization with CalliSpheres beads loaded with arsenic trioxide versus arsenic trioxide iodized oil emulsion in treatment of unresectable liver cancer

Funds: 

China foundation for the promotion of health XM_2018_011_0006_01

Key R&D and Promotion Special Project (Science and Technology Research) of Henan Province 202102310462

  • 摘要:   目的  探讨经肝动脉化疗栓塞术(TACE)中应用三氧化二砷(ATO)载药栓塞微球和ATO碘油乳剂栓塞治疗不可切除的肝癌成本效益。  方法  选择2017年5月—2018年12月在郑州大学第一附属医院就诊的100例中晚期原发性肝癌患者作为研究对象,根据治疗方案不同分为CBATO组(n=45)和cTACE组(n=55)。采用无进展生存期(PFS)进行质量调整寿命年(QALY)的疗效评价,采用欧洲五维健康量表(EQ-5D)指数评估患者的生活质量。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验,计算2组患者的手术次数、住院时间、治疗成本和增量成本效果比(ICER),并进行成本效益分析。  结果  在PFS内,CBATO组和cTACE组治疗中晚期肝癌的人均住院费用分别为96 446元和91 230.43元。2组间平均手术次数(2.5±0.7 vs 3.4±0.8)和平均住院时间[(5.8±1.2) d vs (7.5±1.8) d]比较,差异均有统计学意义(t值分别为16.911、12.459,P值均<0.01);CBATO组QALY高于cTACE组(0.804>0.512)。与cTACE组相比,CBATO组治疗不可切除肝癌的增量成本效益比为17 861.53元/年。  结论  CBATO组手术花费虽高于cTACE组,但在减少手术次数和住院时间的同时其临床疗效优于cTACE组,术后患者的生活质量高于cTACE组,具有明显的成本效益优势。

     

  • 图  1  CBATO组合cTACE组术后近期疗效比较

    表  1  2组患者的一般资料比较

    项目 CBATO组(n=45) cTACE(n=55) 统计值 P
    年龄(岁) 58.94±9.89 55.14±9.03 t=0.478 0.491
    性别[例(%)] χ2=0.112 0.738
      男 41(91.1) 49(89.1)
      女 4(8.9) 6(10.9)
    病因学[例(%)] χ2=0.455 0.500
      HBV 39(86.7) 50(90.9)
      其他 6(13.3) 5(9.1)
    ECOG[例(%)] χ2=0.026 0.872
      0 23(51.1) 29(52.7)
      1 22(48.9) 26(47.3)
    Child分级[例(%)] χ2=2.899 0.089
      A 39(86.7) 40(72.7)
      B 6(13.3) 15(27.3)
    肝硬化[例(%)] χ2=1.010 0.315
      是 38(84.5) 42(76.4)
      否 7(15.5) 13(23.6)
    BCLC分期[例(%)] χ2=0.004 0.952
      B 24(53.3) 29(52.7)
      C 21(46.7) 26(47.3)
    肿瘤大小[例(%)] χ2=0.134 0.714
      ≤5 cm 27(60.0) 31(56.4)
      >5 cm 18(40.0) 24(43.6)
    下载: 导出CSV

    表  2  CBATO组与cTACE组直接医疗费用比较

    分类 CBATO组 cTACE组 差异
    综合医疗服务费用(元)
      床位费 232 376 -144
      护理费 169 258 -89
      一般医疗服务费 489 1184 -695
    诊断费用(元)
      实验室诊断费用 929.67 1 489.90 -560.23
      影像学诊断费用 2 002.75 2 322.21 -319.46
    术中花费(元)
      其他术中花费(手术费+器械费) 11 727.04 12 605.94 521.10
      栓塞材料费 21 562.43 5 997.89 15 564.54
    并发症处理花费(元) 1 466.51 2 598.54 -1 132.03
    合计(元) 38 578.4 26 832.48 11 745.92
    注:差异为CBATO组的花费减去cTACE组的花费。
    下载: 导出CSV

    表  3  EQ-5D指数表

    时间点 CBATO组(n=45) cTACE组(n=55) t P
    术前 0.57±0.12 0.60±0.13 1.545 0.219
    术后1个月 0.71±0.19 0.67±0.17 6.379 0.014
    术后3个月 0.77±0.11 0.70±0.18 28.302 <0.01
    术后6个月 0.76±0.11 0.69±0.10 28.212 <0.01
    下载: 导出CSV

    表  4  2组治疗方案成本-效益比较

    组别 总成本(元) 效益(%) 成本/效益比 QALY(元/QALY) ICER(元/QALY)
    CBATO组 96 446.00 71.1 1 356.48 0.804 17 861.53
    cTACE组 91 230.43 45.6 2 000.67 0.512
    下载: 导出CSV

    表  5  患者平均住院时间和手术次数对比

    组别 手术次数(次) 单次住院天数(d)
    CBATO组 2.5±0.7 5.8±1.2
    cTACE组 3.4±0.8 7.5±1.8
    t 16.911 12.459
    P <0.01 <0.01
    下载: 导出CSV
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  • 收稿日期:  2021-01-21
  • 修回日期:  2021-02-08
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