Navigate作为前列腺癌患者及其伴侣的治疗决策辅助工具的成本-效用分析，与常规护理的比较
Cost-utility Analysis of Navigate, a Treatment Decision Aid for Men with Prostate Cancer and Their Partners, in Comparison to Usual Care
影响因子:9.30000
分区:医学1区 Top / 泌尿学与肾脏学1区 肿瘤学2区
发表日期:2025 Jun
作者:
Daniel Lindsay, Penelope Schofield, Matthew J Roberts, John Yaxley, Stephen Quinn, Natalie Richards, Mark Frydenberg, Robert Gardiner, Nathan Lawrentschuk, Ilona Juraskova, Declan G Murphy, Louisa G Collins
摘要
关于用于指导前列腺癌患者管理决策的决策辅助工具的成本效益的证据有限。我们评估了Navigate在线决策辅助工具在男性前列腺癌患者中的成本效用，与无决策辅助的常规护理进行比较。采用具有10年时间跨度的马尔可夫模型，从政府医疗保健角度构建。模型参数主要来自Navigate试验（n=302）及相关已发表研究。计算两种策略的增量成本和质量调整生命年（QALYs）。进行单因素和概率敏感性分析，以应对模型不确定性。结果显示，Navigate策略平均成本为AU$8899（95%不确定区间：AU$7509-10438），产生7.08 QALYs（95%不确定区间：6.73-7.36），而常规护理成本为AU$9559（95%不确定区间：AU$8177-11017），QALYs为7.03（95%不确定区间：6.67-7.31）。Navigate策略在成本和QALYs方面均优于常规护理，尽管差异较小。以每获得1个QALY支付上限AU$50000为基准，Navigate的成本效益概率为99.7%。本研究受限于所用数据的可得性、质量和选择。使用在线决策辅助工具指导澳大利亚前列腺癌患者的管理，显示具有成本效益，主要是因为更高的主动监测接受率。推广决策辅助工具，有助于更好地向患者传达管理方案。
Abstract
Evidence on the cost effectiveness of decision aids to guide management decisions for men with prostate cancer is limited. We examined the cost utility of the Navigate online decision aid for men with prostate cancer in comparison to usual care (no decision aid).A Markov model with a 10-yr time horizon was constructed from a government health care perspective. Data from the Navigate trial (n = 302) and relevant published studies were used for model inputs. Incremental costs and quality-adjusted life-years (QALYs) were calculated for the two strategies. One-way and probabilistic sensitivity analyses were undertaken to address model uncertainty.On average, the Navigate strategy was estimated to cost AU$8899 (95% uncertainty interval [UI] AU$7509-AU$10438) and produce 7.08 QALYs (95% UI 6.73-7.36) in comparison to AU$9559 (95% UI AU$8177-AU$11017) and 7.03 QALYs (95% UI 6.67-7.31) or usual care. The Navigate strategy dominated usual care as it produced cost-savings and higher QALYs, although differences for both outcomes were small over 10 yr. The likelihood of Navigate being cost effective at a conventionally acceptable threshold of AU$50000 per QALY gained was 99.7%. This study is limited by the availability, quality, and choice of the data used in the model.Use of an online decision aid for men with prostate cancer appears to be cost effective relative to usual care in Australia, driven by the higher acceptance and uptake of active surveillance. Wider implementation of decision aids may better inform men diagnosed with prostate cancer about their management options.We looked at the cost effectiveness of an online decision aid for guiding Australian men with prostate cancer in choosing a management option. We found that this decision aid was cost effective, mainly because more men chose active surveillance. Decision aids that inform patients about their management options should be more widely used in health care.