| アブストラクト | OBJECTIVE: Hospital treatment volume affects survival in patients with endometrial cancer; notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan. METHODS: A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and high-volume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses. RESULTS: A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of yen5,000,000 with a maximum of yen3,777,830/4.28 QALY for the high- and intermediate-risk group, and yen2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or low-volume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and low-risk groups, respectively. CONCLUSION: Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer. |
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| 投稿者 | Machida, Hiroko; Matsuo, Koji; Higashi, Takahiro; Aoki, Daisuke; Enomoto, Takayuki; Okamoto, Aikou; Katabuchi, Hidetaka; Nagase, Satoru; Mandai, Masaki; Yaegashi, Nobuo; Yamagami, Wataru; Mikami, Mikio |
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| 組織名 | Department of Obstetrics and Gynecology, Tokai University School of Medicine,;Isehara, Japan.;Department of Obstetrics and Gynecology, Toyohashi Municipal Hospital, Aichi,;Japan.;Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,;University of Southern California, Los Angeles, CA, USA.;Norris Comprehensive Cancer Center, University of Southern California, Los;Angeles, CA, USA.;National Cancer Center Japan, Institute for Cancer Control, Tokyo, Japan.;Department of Obstetrics and Gynecology, International University of Health and;Welfare Graduate School, Tokyo, Japan.;Department of Obstetrics and Gynecology, Niigata University School of Medicine,;Niigata, Japan.;Department of Obstetrics and Gynecology, Jikei University School of Medicine,;Tokyo, Japan.;Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto;University, Kumamoto, Japan.;Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine,;Yamagata, Japan.;Department of Obstetrics and Gynecology, Kyoto University Graduate School of;Medicine, Kyoto, Japan.;Department of Obstetrics and Gynecology, Tohoku University, Sendai, Japan.;Department of Obstetrics and Gynecology, Keio University School of Medicine,;Isehara, Japan. mmikami@is.icc.u-tokai.ac.jp. |
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