前列腺癌及其伴侣治疗决策辅助工具Navigate的成本-效用分析，比较常规护理
Cost-utility Analysis of Navigate, a Treatment Decision Aid for Men with Prostate Cancer and Their Partners, in Comparison to Usual Care
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影响因子:9.3
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
DOI:
10.1016/j.euo.2024.08.005
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前列腺癌患者中的成本效用，并与常规护理（无决策辅助工具）进行比较。采用10年时间范围的Markov模型，从政府卫生保健视角建模。模型参数使用Navigate试验（n=302）及相关已发表研究的数据。计算两种策略的增量成本和质量调整生命年（QALYs）。进行单向敏感性分析和概率敏感性分析以应对模型不确定性。结果显示，Navigate策略的平均成本估计为AU$8899（95%不确定区间[UI] AU$7509-AU$10438），产生7.08 QALYs（95% UI 6.73-7.36），而常规护理的成本为AU$9559（95% UI AU$8177-AU$11017），QALYs为7.03（95% UI 6.67-7.31）。Navigate策略在成本和QALYs方面均优于常规护理，虽然两者差异较小。以澳大利亚的每QALY AU$50000的接受阈值来看，Navigate的成本效益概率为99.7%。本研究受限于模型所用数据的可用性、质量和选择。使用在线决策辅助工具对前列腺癌患者的管理具有成本效益，主要因主动监测的接受率和采用率较高。推广决策辅助工具有助于更好地向患者传达管理方案。我们评估了为澳大利亚前列腺癌患者提供的在线决策辅助工具的成本效益，发现其具有成本效益，主要原因是更多患者选择主动监测。应更广泛地应用能告知患者管理选择的决策辅助工具，以改善医疗决策。
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.