局部晚期直肠癌新辅助治疗后“观察等待”策略的经济评价——系统综述
Economic Evaluation of 'Watch and Wait' Following Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review
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影响因子:3.5
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2025 Jan
作者:
Ishraq Murshed, Zachary Bunjo, Warren Seow, Ishmam Murshed, Sergei Bedrikovetski, Michelle Thomas, Tarik Sammour
DOI:
10.1245/s10434-024-16056-4
摘要
由于多模态治疗和复杂手术，局部晚期直肠癌（LARC）对医疗系统造成巨大负担。观察等待（W&W）策略可能通过免除手术和住院治疗，从而节省成本。本系统综述旨在评估在新辅助治疗后达到完全临床反应（cCR）患者中，W&W相较于标准治疗的经济影响。系统检索了PubMed、OVID Medline、OVID Embase和Cochrane CENTRAL数据库，从起始至2024年4月26日。纳入所有比较W&W与标准治疗的经济评价（EEs）。通过CHEERS、BMJ和Philips检查表评估报告和方法学质量。采用叙述性合成。主要和次要结局为（增量）成本效益比和净财务成本。在1548篇研究中，筛选出27篇全文符合条件，最终纳入8个国家（2016-2024）的12项研究。7项为完整的成本效益分析（模型或试验基础），5项为部分成本分析，方法学设计和报告质量差异显著。W&W在第三方支付者和患者视角均显示出持续的成本效益（n=7）和成本节约（n=12）。不确定性分析识别的关键参数包括W&W中的局部和远处复发率、救援手术、围手术期死亡率，以及W&W和手术的效用值。尽管方法学设计和报告质量存在异质性，W&W在cCR后很可能具有成本效益和成本节约，优于常规手术。临床试验注册号：PROSPERO CRD42024513874。
Abstract
Owing to multimodal treatment and complex surgery, locally advanced rectal cancer (LARC) exerts a large healthcare burden. Watch and wait (W&W) may be cost saving by removing the need for surgery and inpatient care. This systematic review seeks to identify the economic impact of W&W, compared with standard care, in patients achieving a complete clinical response (cCR) following neoadjuvant therapy for LARC.The PubMed, OVID Medline, OVID Embase, and Cochrane CENTRAL databases were systematically searched from inception to 26 April 2024. All economic evaluations (EEs) that compared W&W with standard care were included. Reporting and methodological quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), BMJ and Philips checklists. Narrative synthesis was performed. Primary and secondary outcomes were (incremental) cost-effectiveness ratios and the net financial cost.Of 1548 studies identified, 27 were assessed for full-text eligibility and 12 studies from eight countries (2016-2024) were included. Seven cost-effectiveness analyses (complete EEs) and five cost analyses (partial EEs) utilized model-based (n = 7) or trial-based (n = 5) analytics with significant variations in methodological design and reporting quality. W&W showed consistent cost effectiveness (n = 7) and cost saving (n = 12) compared with surgery from third-party payer and patient perspectives. Critical parameters identified by uncertainty analysis were rates of local and distant recurrence in W&W, salvage surgery, perioperative mortality and utilities assigned to W&W and surgery.Despite heterogenous methodological design and reporting quality, W&W is likely to be cost effective and cost saving compared with standard care following cCR in LARC. Clinical Trials Registration PROSPERO CRD42024513874.