COST-UTILITY OF VARIOUS BIOLOGIC VERSUS ENDOPROSTHETIC RECONSTRUCTION FOR PRIMARY BONE SARCOMA OF THE HUMERUS

Abstract

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%.