HPB : the official journal of the International Hepato Pancreato Biliary Association · 2025
The "Big short" of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. A cost-effectiveness analysis based on randomized trials.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ricci Claudio, Alberici Laura, D'Ambra Vincenzo, Ingaldi Carlo, Fichera Marco, Casadei Riccardo
Аннотация
BACKGROUND: The cost-effectiveness of a laparoscopic (LPD) and robotic pancreaticoduodenectomy (RPD), compared with the open approach (OPD), is still under debate.
METHODS: A Markov decision model was developed to compare OPD, LPD, and RPD. The healthcare costs and quality-adjusted life years (QALYs) were estimated by calculating the incremental cost-effectiveness ratio (ICER) per QALY gained. A willingness-to-pay (WTP) of $130,049 was assumed as the threshold. A probabilistic sensitivity analysis (PSA) was performed to reflect the uncertainty of various parameters.
RESULTS: In the base case scenario, LPD and RPD were associated with increased costs of US $30,047 and US $30,822, respectively, leading to an ICER of US $-3,911,669 and US $-1,164,992 per QALY. When comparing LPD with OPD, three main factors influence the model: OPD costs (68.8 %), LPD costs (27.9 %), and the complication rate after LPD (2.3 %). In comparing RPD with OPD, two main factors affect the model: RPD costs (75.2 %) and OPD costs (23.3 %). PSA analysis confirmed that OPD was the most cost-effective choice in most cases (62.6 %), while RPD and LPD were the most cost-effective procedures in 26.2 % and 11.9 %, respectively.
CONCLUSION: The RDP and LPD were not cost-effective. OPD remained the best approach.
METHODS: A Markov decision model was developed to compare OPD, LPD, and RPD. The healthcare costs and quality-adjusted life years (QALYs) were estimated by calculating the incremental cost-effectiveness ratio (ICER) per QALY gained. A willingness-to-pay (WTP) of $130,049 was assumed as the threshold. A probabilistic sensitivity analysis (PSA) was performed to reflect the uncertainty of various parameters.
RESULTS: In the base case scenario, LPD and RPD were associated with increased costs of US $30,047 and US $30,822, respectively, leading to an ICER of US $-3,911,669 and US $-1,164,992 per QALY. When comparing LPD with OPD, three main factors influence the model: OPD costs (68.8 %), LPD costs (27.9 %), and the complication rate after LPD (2.3 %). In comparing RPD with OPD, two main factors affect the model: RPD costs (75.2 %) and OPD costs (23.3 %). PSA analysis confirmed that OPD was the most cost-effective choice in most cases (62.6 %), while RPD and LPD were the most cost-effective procedures in 26.2 % and 11.9 %, respectively.
CONCLUSION: The RDP and LPD were not cost-effective. OPD remained the best approach.
Предметные рубрики MeSH
HumansCost-Benefit AnalysisPancreaticoduodenectomyQuality-Adjusted Life YearsPancreatic NeoplasmsMarkov ChainsRandomized Controlled Trials as TopicRobotic Surgical ProceduresLaparoscopyModels, EconomicCarcinoma, Pancreatic DuctalTreatment OutcomeHealth Care CostsDecision Support TechniquesMaleCost-Effectiveness Analysis