COST-UTILITY OF VARIOUS BIOLOGIC VERSUS ENDOPROSTHETIC RECONSTRUCTION FOR PRIMARY BONE SARCOMA OF THE HUMERUS
Keywords:Primary bone sarcoma, Humerus bone cancer, Bone reconstruction, Cost-utility analysis, Various biologic reconstruction, Endoprosthesis reconstruction
Background: The development of bone sarcoma treatment has resulted in a higher survival rate of patients including the developed surgical treatment called limb salvage surgery. Reconstructive surgery plays a vital role among patients and their quality of life after treatment. However, cost-effectiveness is another crucial factor in choosing a treatment method.
Methods: Eighteen patients with osteosarcoma were recruited in this study. All were treated using limb salvage surgery. The data were collected using the utility coefficient from the EQ-5D-5L Health Questionnaire. The patient’s medical cost was obtained from Phramongkutklao Hospital, and all data were calculated for cost-effectiveness using the cost-utility analysis.
Results: Endoprosthesis reconstruction exhibited the highest utility value of 0.85 QALY and the lowest treatment complications. Nevertheless, the most increased cost was an average of 238,432.34 THB. In terms of cost, the recycled autograft showed the lowest treatment cost at an average of 60,774.61 THB. However, the complication of this method was quite severe, with a 50% recurrence rate. Allograft reconstruction was the most cost-effective method with a lower cost than endoprosthesis reconstruction (61,341.40 THB), despite having a lower utility of 0.49 QALY.
Conclusion: This study reported that endoprosthesis reconstruction resulted in more optimistic patient well-being but still indicated high cost. Using one-way sensitivity analysis, the QALY gain was only 16.9% of Thai per capita. When the cost of endoprosthesis reconstruction was reduced by only 15%, it could replace allograft reconstruction. In addition, an increase of the QALY, gaining only 20% of the average Thai per capita, would be cost-effective when the expense of endoprosthesis reconstruction was reduced by 4%.
Darling J.A different view of sarcoma statistics. ESUN 2007; 4: 1-7. http://sarcomahelp.org/articles/sarcoma-statistics.html
DeVita VT, Lawrence TS, Rosenberg SA. Principles and Practice of Oncology. Lippincott Williams & Wilkins 2019; 11: 2037-68.
Julian MS, Garcia BV. Biological reconstruction in bone sarcomas: Lessons from three decades of experience. Orthop Surg 2016; 8: 111-21. DOI: https://doi.org/10.1111/os.12243
American Joint Committee on Cancer. Bone. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 471-86.
Wilson RJ, Sulieman LM, VanHouten JP. Halpern J, Schwartz HS, Devin CJ, et al. Cost-utility of osteoarticular allograft versus endoprosthetic reconstruction for primary bone sarcoma of the knee: A markov analysis. Surg Oncol 2017; 115: 257–65. DOI: https://doi.org/10.1002/jso.24525
van de Sande MAJ, Dijkstra PDS, Taminiau AHM. Proximal humerus reconstruction after tumor resection: biological versus endoprosthetic reconstruction. Int Orthop 2011; 35: 1375-80. DOI: https://doi.org/10.1007/s00264-010-1152-z
Grobet CE, Glanzmann MC, Eichler K. Costutility analysis of total shoulder arthroplasty: a prospective health economic study using real-world data. J Shoulder Elbow Surg 2021; 30: 1998-2006. DOI: https://doi.org/10.1016/j.jse.2021.03.136
Losina E, Walensky RP, Kessler CL. Costeffectiveness of total knee arthroplasty in the United States: Patient risk and hospital volume. Arch Intern Med 2009; 169: 1113–21. DOI: https://doi.org/10.1001/archinternmed.2009.136
Gundle KR, Cizik AM, Punt SE, Conrad EU, Davidson DJ. Validation of the SF -6D health state utilities measure in lower extremity sarcoma. Sarcoma 2014; 2014(450902): 1-4. DOI: https://doi.org/10.1155/2014/450902
Pattanaphesaj J. Health-related quality of life measure (EQ-5D-5L): measurement property testing and its preference-based score in Thai population [Doctoral dissertation]: Mahidol University; 2014. Available from https://www.hitap.net/wp-content/uploads/2016/11/EQ5D_thesis_final-copy.compressed.pdf
NESDC Economic Report 15th August 2022; Office of the Economic and Social Development Council, Thailand. Available from https://www.nesdc.go.th/nesdb_en/article_attach/article_file_20220830093238.pdf
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