摘要
目的 从全社会角度出发,评估机器人辅助腹腔镜手术(RALS)和传统腹腔镜手术(CLS)治疗早期子宫内膜癌(EC)的经济性。方法 构建决策树模型,进行成本-效用分析,模拟患者术中到术后的短期病情发展。主要评价指标包括累计成本、质量调整生命年(QALY)及增量成本-效果比(ICER)。将支付意愿(WTP)阈值设定为2024年我国的3倍人均GDP。通过敏感性分析评估模型的稳健性。结果 基础分析表明,相比于CLS组,RALS组患者在获得额外0.09个QALY的同时,成本增加了39 079.52元,ICER为437 157.36元/QALY,超过预先设定的WTP阈值。结果表明,与CLS相比,RALS在早期EC治疗中没有表现出更高的短期成本-效用。单因素敏感性分析结果显示,当每台机器人设备的年手术量达到809台时或每台机器人手术所用的Endowrist耗材成本降到6 568.46元以下时,RALS将成为更具成本-效用的手术策略。概率敏感性分析进一步揭示,当WTP阈值超过402 145.80元时,RALS的成本-效用优势将更为显著。结论 从我国全社会角度来看,在目前3倍人均GDP的支付意愿阈值下,相比于CLS,RALS治疗早期子宫内膜癌不具有经济性。
Objective To evaluate the cost-effectiveness of robot-assisted laparoscopic surgery(RALS)versus conventional laparoscopic surgery(CLS)for early-stage endometrial cancer(EC)from a societal perspective.Methods A decision-tree model was constructed to conduct cost-utility analysis,simulating the short-term intraoperative to postoperative clinical progression of patients.Primary evaluation metrics included cumulative costs,quality-adjusted life years(QALYs),and incremental cost-effectiveness ratio(ICER).The willingness-to-pay(WTP)threshold was set at three times the 2024 per capita gross domestic product(GDP)of China.The sensitivity analyses were performed to assess robustness of the model.Results The base-case analysis revealed that patients in the RALS group gained o.09 more QALYs at an additional cost of￥39079.52 compared with CLS group,the derived ICER was￥437157.36/QALYs,exceeding the predefined WTP threshold.The results suggested that RALS does not demonstrate superior costeffectiveness compared with CLS in the management of early-stage EC.Univariate sensitivity analysis indicated that,when the annual surgical volume per robotic device reaches 809 cases,or the cost of Endowrist consumables per robotic surgery drops below Y6568.46,RALS will emerge as a more cost-effective surgical strategy.The probabilistic sensitivity analysis revealed that that RALS becomes more cost-effective when the WTP threshold exceeds Y402145.80.Conclusion From a Chinese societal perspective,robotic-assisted laparoscopic surgery for early-stage endometrial cancer is not cost-effective compared with conventional laparoscopic surgery at the current WTP threshold of three times per capita GDP.
作者
张敏
浦科学
ZHANG Min;PU Kexue(School of Medical Informatics,Chongqing Medical University,Chongqing 400016,P.R.China)
出处
《中国循证医学杂志》
北大核心
2025年第11期1296-1300,共5页
Chinese Journal of Evidence-based Medicine
基金
国家社科基金项目(编号:22XGL012)
重庆医科大学未来医学科研创新团队项目(编号:W0081)。
关键词
子宫内膜癌
机器人辅助腹腔镜手术
传统腹腔镜手术
成本-效用分析
Endometrial cancer
Robot-assisted laparoscopic surgery
Conventional laparoscopic surgery
Costutility analysis
