We aimed to investigate the cost-effectiveness of open surgery, compared to minimally invasive radical hysterectomy for early-stage cervical cancer, using updated survival data. Costs and utilities of each surgical approach were compared using a Markovian decision analysis model. Survival data stratified by surgical approach and surgery costs were received from recently published data. Average costs were discounted at 3%. The value of health benefits for each strategy was calculated using quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio, calculated using the formula (average cost minimal invasive surgery—average cost open surgery)/(average QALY minimal invasive surgery—average QALY open surgery), was used for cost-effectiveness analysis. One-way sensitivity analysis was conducted for all variables. Open radical hysterectomy was found to be cost-saving compared to minimally invasive surgery with an incremental cost-effectiveness ratio of USD −66 and USD −373 for laparoscopic and robotic surgery, respectively. The most influential parameters in the model were surgery costs, followed by the disutility involved with open surgery. Until further data are generated regarding the survival of patients with early-stage cervical cancer treated by minimally invasive surgery, at current pricing, open radical hysterectomy is cost-saving compared to minimally invasive radical hysterectomy, both laparoscopic and robotic.
本研究旨在利用更新的生存数据，探讨开放手术与微创根治性子宫切除术治疗早期宫颈癌的成本效益。通过马尔可夫决策分析模型比较了两种手术方式的成本与效用值。手术方式分层后的生存数据及手术费用来源于近期发表的研究数据，平均成本按3%进行折现。各策略的健康效益值通过质量调整生命年（QALYs）进行计算。采用增量成本效益比（计算公式为：（微创手术平均成本-开放手术平均成本）/（微创手术平均QALY-开放手术平均QALY））进行成本效益分析，并对所有变量进行单因素敏感性分析。结果显示，与微创手术相比，开放根治性子宫切除术具有成本节约优势：腹腔镜手术与机器人手术的增量成本效益比分别为-66美元和-373美元。模型中影响最大的参数是手术成本，其次是开放手术相关的效用损失。在当前定价体系下，针对早期宫颈癌的治疗，在获得更多关于微创手术患者生存数据之前，开放根治性子宫切除术（包括腹腔镜与机器人手术）相比微创根治性子宫切除术具有更优的成本效益。
肿瘤(癌症)患者之家