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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。
Objective To establish a health economics evaluation model of transcatheter arterial chemoembolization (TACE) after radical resection of hepatocellular carcinoma (HCC). Methods One hundred and forty patients with HCC were randomly divided into TACE group and non-TACE group (outpatient follow-up group). The direct medical costs and treatment effects (recurrence rate and disease-free survival time) of the two groups were collected and analyzed for cost-effectiveness , Incremental cost effectiveness analysis and sensitivity analysis. Results (1) The average cost of outpatients in 40 non-TACE patients was 7 121.44 yuan / person; the total cost before relapse in 100 TACE patients was 82 525.45 yuan / person. (2) The recurrence rates at 1, 2, 3, 4 and 5 years in non-TACE group and TACE group were not significantly different (P> 0.05). There was no significant difference between the two groups in tumor-free survival time (P = 0.322 ). (3) The cost-effectiveness ratio of non-TACE group was 389.15 yuan / month, that of TACE group was 1 278.30 yuan / month, and the incremental cost-effectiveness ratio was 5 560.27 yuan / month. (4) The cost-effectiveness ratio of non-TACE group was 350.84 yuan / month in sensitivity analysis, 215.81 yuan / month in TACE group and 5 381.35 yuan / month in TACE group. Conclusions From the perspective of health economics, prophylactic TACE is not the optimal strategy to prevent postoperative recurrence of liver cancer. At least not every patient should or should be fit to do so. Out-patient follow-up with the same effect (recurrence rate, tumor-free survival time) Treatment may be more economical.