双孔机器人手术与单孔胸腔镜手术治疗非小细胞肺癌的成本效益分析  

Cost-effectiveness analysis of dual-portal robot-assisted thoracic surgery and uniportal video-assisted thoracoscopic surgery in the treatment of non-small cell lung cancer

作　　者：王树民 李飞[2] 褚恒 张哲[2] WANG Shumin;LI Fei;CHU Heng;ZHANG Zhe(School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China;Department of Thoracic Surgery,Qingdao Municipal Hospital,Qingdao 266071,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261053 [2]青岛市市立医院胸外科,山东青岛266071

出　　处：《机器人外科学杂志(中英文)》2025年第3期383-387,共5页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金(2204152)。

摘　　要：目的:探究接受双孔机器人手术(DRATS)和单孔胸腔镜手术(UVATS)对非小细胞肺癌患者的成本效益。方法:选取2021年1月—2022年10月于青岛市市立医院接受手术的非小细胞肺癌(NSCLC)患者作为研究对象。根据手术方式的不同将其分为DRATS组和UVATS组,利用马尔科夫决策模型,对NSCLC患者术后1年和第2年的疾病进展进行模拟分析,以评估患者的医疗成本和收益,探讨DRATS与UVATS的成本效益。结果:在术后1年内,DRATS组相较于UVATS组增加了0.01质量调整生命年(QALY),增量成本效益比(ICER)为57307.00 USD/QALY。在术后2年内,DRATS组额外支付了1720.26 USD,增加了0.04 QALY,DRATS组的ICER为43006.50 USD/QALY。学习曲线也对DRATS组的成本效益有影响。根据山东省的支付意愿,DRATS组不具有明显的成本效益。结论:DRATS能使患者获得更好的生活质量,从术后2年随访结果来看,接受DRATS的患者获益逐渐增加。此外,主刀医生丰富的手术经验和手术团队的融洽合作有助于提高DRATS的成本效益。然而,DRATS最明显的劣势是昂贵的手术费用,这导致DRATS在社会经济水平较发达的城市更具有成本效益。Objective:To explore the cost-effectiveness of dual-portal robot-assisted thoracic surgery(DRATS)versus uniportal videoassisted thoracic surgery(UVATS)in patients undergoing these procedures.Methods:Patients with non-small cell lung cancer(NSCLC)who underwent surgery at Qingdao Municipal Hospital from January to and October 2022 were enrolled.They were divided into the DRATS group and the UVATS group based on different surgical approaches.A Markov decision process model was developed to simulate disease progression during the first and second year after surgery,assessing medical costs and outcomes to evaluate the cost-effectiveness of DRATS versus UVATS.Results:Within the first year after surgery,the DRATS group gained 0.01 additional quality-adjusted life years(QALYs)compared to the UVATS group,with an incremental cost-effectiveness ratio(ICER)of 57307.00 USD/QALY.Over a twoyear postoperative period,the DRATS group incurred an incremental cost of 1720.26 USD and gained 0.04 additional QALYs,resulting in an ICER of 43006.50 USD/QALY.The cost-effectiveness of DRATS is also influenced by the learning curve.Based on the willingnessto-pay threshold in Shandong Province,DRATS did not demonstrate significant cost-effectiveness.Conclusion:DRATS could improve patients’quality of life,with incremental benefits over a two-year follow-up.Surgeons’extensive experience and cohesive teamwork can enhance the cost-effectiveness of DRATS.However,the high costs of DRATS remain a critical limitation,rendering it more cost-effective in socioeconomically developed regions.

关 键 词：非小细胞肺癌 单孔胸腔镜手术 达芬奇机器人手术 成本效益 

分 类 号：R655[医药卫生—外科学]