我国手术切除与射频消融治疗早期肝细胞癌的经济学评价  

Economic Evaluation on Surgical Resection and Radiofrequency Ablation for Early Hepatocellular Carcinoma in China

作　　者：熊琨 陆勇[2] 沈兵[3] 朱莉萍 薛迪[1] XIONG Kun;LU Yong;SHEN Bing(School of Public Health, Fudan University,NHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, 200032, China)

机构地区：[1]复旦大学公共卫生学院国家卫健委卫生技术评估重点实验室(复旦大学),上海200032 [2]上海交通大学医学院附属瑞金医院医务处,上海200025 [3]上海市第一人民医院设备处,上海200080

出　　处：《中国卫生经济》2019年第10期72-75,共4页Chinese Health Economics

摘　　要：目的:对我国手术切除(SR)和射频消融(RFA)治疗符合Milan标准且肝功能为Child-Pugh A或B级的早期肝细胞癌(HCC )患者的成本-效用进行比较。方法通过机构调查、系统综述和专家咨询收集相关数据,并从卫生系统视角构建Markov模型,比较手术切除和射频消融的成本-效用分析。结果当模型运行时间W 3年时,RFA比SR更具成本-效果;而当模型运行时间>3年时,SR-RFA的1CER值均低于3倍人均GDP, SR更具成本-效果。概率敏感性分析显示,当模型运行20年、意愿支付阈值为3倍人均GDP时,SR比RFA更具有成本-效果的概率为75.2%。结论从长期疗效和经济性来看,早期HCC的治疗应首选手术切除。Objective: To compare cost-utility between surgical resection(SR) and radiofrequency ablation(RFA) for early hepatocellular carcinoma(HCC) with Child-Pugh A/B liver function and Milan criteria. Methods: From the perspective of health system, a Markov model was constructed to compare the cost-utilities between SR and RFA, based on the relevant data from institutional surveys, systematic reviews and expert consultation. Results: When the model ran for <3 years, RFA was more cost- effective than SR, while the model ran for >3 years, the ICER value of SR-RFA was less than 3 times of GDP per capita and SR was more cost-effective. Probabilistic sensitivity analysis showed that when the model ran for 20 years and the willingness to pay threshold was 3 times of GDP per capita, the probability of SR being more cost-effective than RFA was 75.2%. Conclusion: Considering long term efficacy and economy, SR should the first choice for early HCC.

关 键 词：肝细胞癌 手术切除 射频消融 成本-效用分析 MARKOV模型 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F224[经济管理—国民经济]