Cost effectiveness of a new strategy to identify HNPCC patients

Cost effectiveness of a new strategy to identify HNPCC patients
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DOI：
10.1136/gut.2004.039123
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发表时间：
2005-01-01
期刊：
GUT
影响因子：
24.5
通讯作者：
Hoogerbrugge, N
Hoogerbrugge, N
中科院分区：
医学1区
文献类型：
--
作者：
Kievit, W;de Bruin, JHFM;Hoogerbrugge, N

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背景：区分遗传性非息肉病性结直肠癌 (HNPCC) 与非遗传性结直肠癌 (CRC) 可以延长 HNPCC 患者及其近亲的预期寿命。目的：使用病理学家可以应用的新检测肿瘤的微卫星不稳定性 (MSI) 分析简单标准，确定检测 HNPCC 的新策略的有效性、效率和可行性。 MSI分析的标准是：（1）50岁之前的CRC； (2)第二个CRC； (3)CRC和HNPCC相关癌症； (4) 40 岁之前的腺瘤。方法：根据当前实践评估新策略的功效和成本效益。构建决策分析模型来估计额外 HNPCC 突变携带者的数量以及该策略的成本。通过马尔可夫模型评估了 HNPCC 突变携带者的增量成本和预期寿命的增加。在五家医院探讨了可行性。结果：使用新策略，与当前做法相比，可以在 CRC 人群中识别出多 2.2 倍的 HNPCC 患者。研究发现，这一新策略具有成本效益，每个生命年的预期成本效益比为 E3801。当包括兄弟姐妹和儿童群体时，每增加一个生命年，成本效益比变为 E2184。敏感性分析显示这些结果是稳健的。结论：对新诊断的 CRC 患者进行 MSI 检测被证明是具有成本效益的，并且是识别无家族史的 HNPCC 风险患者的可行方法。
Background: Distinguishing hereditary non-polyposis colorectal cancer (HNPCC) from non-hereditary colorectal cancer (CRC) can increase the life expectancy of HNPCC patients and their close relatives.Aim: To determine the effectiveness, efficiency, and feasibility of a new strategy for the detection of HNPCC, using simple criteria for microsatellite instability (MSI) analysis of newly detected tumours that can be applied by pathologists. Criteria for MSI analysis are: (1) CRC before age 50 years; (2) second CRC; (3) CRC and HNPCC associated cancer; or (4) adenoma before age 40 years.Methods: The efficacy and cost effectiveness of the new strategy was evaluated against current practice. Decision analytic models were constructed to estimate the number of extra HNPCC mutation carriers and the costs of this strategy. The incremental costs and gain in life expectancy for a HNPCC mutation carrier were evaluated by Markov modelling. Feasibility was explored in five hospitals.Results: Using the new strategy, 2.2 times more HNPCC patients can be identified among a CRC population compared with current practice. This new strategy was found to be cost effective with an expected cost effectiveness ratio of E3801 per life year gained. When including the group of siblings and children, the cost effectiveness ratio became E2184 per life year gained. Sensitivity analysis showed these findings to be robust.Conclusions: MSI testing in a selection of newly diagnosed CRC patients was shown to be cost effective and a feasible method to identify patients at risk for HNPCC who are not recognised by family history.