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Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)

BACKGROUND: Lungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context. METHODS: Two hundred and fifty nine adult patients from 10 French centres were randomised in this pr...

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Autores principales: Soilly, Anne-Laure, Aho Glélé, Ludwig Serge, Bernard, Alain, Abou Hanna, Halim, Filaire, Marc, Magdaleinat, Pierre, Marty-Ané, Charles, Tronc, François, Grima, Renaud, Baste, Jean-Marc, Thomas, Pascal-Alexandre, Richard De Latour, Bertrand, Pforr, Arnaud, Pagès, Pierre-Benoît
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507914/
https://www.ncbi.nlm.nih.gov/pubmed/37723516
http://dx.doi.org/10.1186/s12913-023-09962-y
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author Soilly, Anne-Laure
Aho Glélé, Ludwig Serge
Bernard, Alain
Abou Hanna, Halim
Filaire, Marc
Magdaleinat, Pierre
Marty-Ané, Charles
Tronc, François
Grima, Renaud
Baste, Jean-Marc
Thomas, Pascal-Alexandre
Richard De Latour, Bertrand
Pforr, Arnaud
Pagès, Pierre-Benoît
author_facet Soilly, Anne-Laure
Aho Glélé, Ludwig Serge
Bernard, Alain
Abou Hanna, Halim
Filaire, Marc
Magdaleinat, Pierre
Marty-Ané, Charles
Tronc, François
Grima, Renaud
Baste, Jean-Marc
Thomas, Pascal-Alexandre
Richard De Latour, Bertrand
Pforr, Arnaud
Pagès, Pierre-Benoît
author_sort Soilly, Anne-Laure
collection PubMed
description BACKGROUND: Lungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context. METHODS: Two hundred and fifty nine adult patients from 10 French centres were randomised in this prospective multicentre randomised controlled trial, between July 29, 2016, and November 24, 2020. Survival from surgical intervention to day 30 and later was compared with the log-rank test. Total quality-adjusted-life-years (QALYs) were calculated using the EQ-5D-3L®. For medico-economic analyses at 30 days and at 3 months after surgery, resources consumed were valorised (€ 2018) from a hospital perspective. First, since mortality was infrequent and not different between the two arms, cost-minimisation analyses were performed considering only the cost differential. Second, based on complete cases on QALYs, cost-utility analyses were performed taking into account cost and QALY differential. Acceptability curves and the 95% confidence intervals for the incremental ratios were then obtained using the non-parametric bootstrap method (10,000 replications). Sensitivity analyses were performed using multiple imputations with the chained equation method. RESULTS: The average cumulative costs of thoracotomy were lower than those of video-thoracoscopy at 30 days (€9,730 (SD = 3,597) vs. €11,290 (SD = 4,729)) and at 3 months (€9,863 (SD = 3,508) vs. €11,912 (SD = 5,159)). In the cost-utility analyses, the incremental cost-utility ratio was €19,162 per additional QALY gained at 30 days (€36,733 at 3 months). The acceptability curve revealed a 64% probability of efficiency at 30 days for video-thoracoscopy, at a widely-accepted willingness-to-pay threshold of €25,000 (34% at 3 months). Ratios increased after multiple imputations, implying a higher cost for video-thoracoscopy for an additional QALY gain (ratios: €26,015 at 30 days, €42,779 at 3 months). CONCLUSIONS: Given our results, the economic efficiency of video-thoracoscopy at 30 days remains fragile at a willingness-to-pay threshold of €25,000/QALY. The economic efficiency is not established beyond that time horizon. The acceptability curves given will allow decision-makers to judge the probability of efficiency of this technology at other willingness-to-pay thresholds. TRIAL REGISTRATION: NCT02502318.
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spelling pubmed-105079142023-09-20 Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01) Soilly, Anne-Laure Aho Glélé, Ludwig Serge Bernard, Alain Abou Hanna, Halim Filaire, Marc Magdaleinat, Pierre Marty-Ané, Charles Tronc, François Grima, Renaud Baste, Jean-Marc Thomas, Pascal-Alexandre Richard De Latour, Bertrand Pforr, Arnaud Pagès, Pierre-Benoît BMC Health Serv Res Research BACKGROUND: Lungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context. METHODS: Two hundred and fifty nine adult patients from 10 French centres were randomised in this prospective multicentre randomised controlled trial, between July 29, 2016, and November 24, 2020. Survival from surgical intervention to day 30 and later was compared with the log-rank test. Total quality-adjusted-life-years (QALYs) were calculated using the EQ-5D-3L®. For medico-economic analyses at 30 days and at 3 months after surgery, resources consumed were valorised (€ 2018) from a hospital perspective. First, since mortality was infrequent and not different between the two arms, cost-minimisation analyses were performed considering only the cost differential. Second, based on complete cases on QALYs, cost-utility analyses were performed taking into account cost and QALY differential. Acceptability curves and the 95% confidence intervals for the incremental ratios were then obtained using the non-parametric bootstrap method (10,000 replications). Sensitivity analyses were performed using multiple imputations with the chained equation method. RESULTS: The average cumulative costs of thoracotomy were lower than those of video-thoracoscopy at 30 days (€9,730 (SD = 3,597) vs. €11,290 (SD = 4,729)) and at 3 months (€9,863 (SD = 3,508) vs. €11,912 (SD = 5,159)). In the cost-utility analyses, the incremental cost-utility ratio was €19,162 per additional QALY gained at 30 days (€36,733 at 3 months). The acceptability curve revealed a 64% probability of efficiency at 30 days for video-thoracoscopy, at a widely-accepted willingness-to-pay threshold of €25,000 (34% at 3 months). Ratios increased after multiple imputations, implying a higher cost for video-thoracoscopy for an additional QALY gain (ratios: €26,015 at 30 days, €42,779 at 3 months). CONCLUSIONS: Given our results, the economic efficiency of video-thoracoscopy at 30 days remains fragile at a willingness-to-pay threshold of €25,000/QALY. The economic efficiency is not established beyond that time horizon. The acceptability curves given will allow decision-makers to judge the probability of efficiency of this technology at other willingness-to-pay thresholds. TRIAL REGISTRATION: NCT02502318. BioMed Central 2023-09-18 /pmc/articles/PMC10507914/ /pubmed/37723516 http://dx.doi.org/10.1186/s12913-023-09962-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Soilly, Anne-Laure
Aho Glélé, Ludwig Serge
Bernard, Alain
Abou Hanna, Halim
Filaire, Marc
Magdaleinat, Pierre
Marty-Ané, Charles
Tronc, François
Grima, Renaud
Baste, Jean-Marc
Thomas, Pascal-Alexandre
Richard De Latour, Bertrand
Pforr, Arnaud
Pagès, Pierre-Benoît
Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)
title Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)
title_full Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)
title_fullStr Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)
title_full_unstemmed Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)
title_short Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)
title_sort medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (lungsco01)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507914/
https://www.ncbi.nlm.nih.gov/pubmed/37723516
http://dx.doi.org/10.1186/s12913-023-09962-y
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