Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)

BMC Health Services Research

Research

Ludwig Serge Aho Glélé¹  Marc Filaire²  Pierre Magdaleinat³  Jean-Marc Baste⁴  François Tronc⁵  Renaud Grima⁵  Pascal-Alexandre Thomas⁶  Pierre-Benoît Pagès⁷  Halim Abou Hanna⁷  Alain Bernard⁷  Bertrand Richard De Latour⁸  Charles Marty-Ané⁹  Arnaud Pforr^1,10  Anne-Laure Soilly^1,11 

[1] Department of Epidemiology, CHU Dijon, Dijon, France;Department of Thoracic Surgery and Endocrine Surgery, Centre Jean Perrin, Clermont Auvergne University, Clermont-Ferrand, France;Department of Thoracic Surgery, AP-HP, Hôpital Cochin, Paris, France;Department of Thoracic Surgery, CHU Rouen, Rouen, France;Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France;Department of Thoracic Surgery, North University Hospital, Aix-Marseille University & APHM, Marseille, France;Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France;Department of Thoracic and Cardiovascular Surgery, CHU Rennes, Rennes, France;Department of Thoracic and Cardiovascular Surgery, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France;Department of Thoracic and Vascular Surgery, Avignon, Avignon, CH, France;Direction of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network, CHU Dijon-Bourgogne, 21000, Dijon, France;

关键词: Cost analysis;    Cost-utility analysis;    Thoracoscopy;    Thoracotomy;    Lung cancer surgery;   

DOI  :  10.1186/s12913-023-09962-y

 received in 2022-06-20, accepted in 2023-08-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundLungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context.MethodsTwo hundred and fifty nine adult patients from 10 French centres were randomised in this prospective multicentre randomised controlled trial, between July 29, 2016, and November 24, 2020. Survival from surgical intervention to day 30 and later was compared with the log-rank test. Total quality-adjusted-life-years (QALYs) were calculated using the EQ-5D-3L®. For medico-economic analyses at 30 days and at 3 months after surgery, resources consumed were valorised (€ 2018) from a hospital perspective. First, since mortality was infrequent and not different between the two arms, cost-minimisation analyses were performed considering only the cost differential. Second, based on complete cases on QALYs, cost-utility analyses were performed taking into account cost and QALY differential. Acceptability curves and the 95% confidence intervals for the incremental ratios were then obtained using the non-parametric bootstrap method (10,000 replications). Sensitivity analyses were performed using multiple imputations with the chained equation method.ResultsThe average cumulative costs of thoracotomy were lower than those of video-thoracoscopy at 30 days (€9,730 (SD = 3,597) vs. €11,290 (SD = 4,729)) and at 3 months (€9,863 (SD = 3,508) vs. €11,912 (SD = 5,159)). In the cost-utility analyses, the incremental cost-utility ratio was €19,162 per additional QALY gained at 30 days (€36,733 at 3 months). The acceptability curve revealed a 64% probability of efficiency at 30 days for video-thoracoscopy, at a widely-accepted willingness-to-pay threshold of €25,000 (34% at 3 months). Ratios increased after multiple imputations, implying a higher cost for video-thoracoscopy for an additional QALY gain (ratios: €26,015 at 30 days, €42,779 at 3 months).ConclusionsGiven our results, the economic efficiency of video-thoracoscopy at 30 days remains fragile at a willingness-to-pay threshold of €25,000/QALY. The economic efficiency is not established beyond that time horizon. The acceptability curves given will allow decision-makers to judge the probability of efficiency of this technology at other willingness-to-pay thresholds.Trial registrationNCT02502318.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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