OBJECTIVES Stage I non-small cell lung cancer (NSCLC) can be treated with either Stereotactic Body Radiotherapy (SBRT) or Video Assisted Thoracic Surgery (VATS) resection. To support decision making, not only the impact on survival needs to be taken into account, but also on quality of life, costs and cost-effectiveness. Therefore, we performed a cost-effectiveness analysis comparing SBRT to VATS resection with respect to quality adjusted life years (QALY) lived and costs in operable stage I NSCLC. MATERIALS AND METHODS Patient level and aggregate data from eight Dutch databases were used to estimate costs, health utilities, recurrence free and overall survival. Propensity score matching was used to minimize selection bias in these studies. A microsimulation model predicting lifetime outcomes after treatment in stage I NSCLC patients was used for the cost-effectiveness analysis. Model outcomes for the two treatments were overall survival, QALYs, and total costs. We used a Dutch health care perspective with 1.5 % discounting for health effects, and 4 % discounting for costs, using 2018 cost data. The impact of model parameter uncertainty was assessed with deterministic and probabilistic sensitivity analyses. RESULTS Patients receiving either VATS resection or SBRT were estimated to live 5.81 and 5.86 discounted QALYs, respectively. Average discounted lifetime costs in the VATS group were €29,269 versus €21,175 for SBRT. Difference in 90-day excess mortality between SBRT and VATS resection was the main driver for the difference in QALYs. SBRT was dominant in at least 74 % of the probabilistic simulations. CONCLUSION Using a microsimulation model to combine available evidence on survival, costs, and health utilities in a cost-effectiveness analysis for stage I NSCLC led to the conclusion that SBRT dominates VATS resection in the majority of simulations.

中文翻译：

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在医学上可行的I期非小细胞肺癌中，立体定向放射疗法与视频辅助胸外科的成本效益：模型研究。

目的可以通过立体定向放射疗法（SBRT）或电视胸腔镜手术（VATS）切除术治疗I期非小细胞肺癌（NSCLC）。为了支持决策，不仅需要考虑对生存的影响，而且还要考虑生活质量，成本和成本效益。因此，我们进行了成本效益分析，比较了SBRT和VATS切除相对于可手术I期NSCLC的生存质量调整寿命（QALY）和成本。材料和方法使用来自八个荷兰数据库的患者水平和汇总数据来估算成本，医疗卫生，无复发和总体生存率。在这些研究中，倾向得分匹配被用于使选择偏倚最小化。使用微仿真模型预测I期非小细胞肺癌患者治疗后的终生结局，以进行成本效益分析。两种治疗的模型结果是总生存期，QALY和总成本。我们使用荷兰卫生保健的观点，使用2018年成本数据将健康影响折现1.5％，将成本折算4％。通过确定性和概率敏感性分析评估模型参数不确定性的影响。结果接受VATS切除或SBRT的患者估计分别生活在5.81和5.86折扣QALYs下。VATS组的平均折扣终身费用为29,269欧元，而SBRT为21,175欧元。SBRT和VATS切除之间90天过高死亡率的差异是QALYs差异的主要驱动因素。SBRT在至少74％的概率模拟中占主导地位。结论在第一阶段非小细胞肺癌的成本-效果分析中，使用微观模拟模型结合生存，成本和健康效用的可用证据得出结论：在大多数模拟中，SBRT在VATS切除术中占主导地位。